On September 17th, the New York State Department of Health (DOH) released a draft proposal describing an amendment to the 1115 Medicaid Redesign Team (MRT) waiver that would extend the Delivery System Reform Incentive Payment (DSRIP) program for a total of four years. DSRIP Year 5 is currently scheduled to end in March 2020. In the draft, DOH proposes to request that the Centers for Medicare & Medicaid Services (CMS) approve an additional federal investment of $8 billion over a four-year time period, consisting of a one-year extension through March 2021 followed by a three-year renewal period through March 2024. This $8 billion would be invested in four program areas:
- DSRIP Performance ($5 billion);
- Workforce Development ($1 billion);
- Social Determinants of Health ($1.5 billion); and
- A second Interim Access Assurance Fund ($500 million).
The renewed DSRIP program would focus on sustaining and expanding “promising practices” identified during the first DSRIP period. It would offer more time and funding to integrate such practices into value-based payment (VBP) contracts. New DSRIP funds would flow to collaborations called Value-Driving Entities (VDEs), which will expand on the Performing Provider System (PPS) concept to include managed care organizations (MCOs), community-based organizations (CBOs), and Qualified Entities (i.e., health information exchanges). Each VDE’s single overarching goal would be to create VBP contracts that fully fund and support DSRIP promising practices and other high-need projects by the end of the renewal period in 2024, which would effectively be DSRIP Year 9 (DY 9).
Other notable alterations to DSRIP under the proposed renewal include:
- Alignment with federal priority initiatives, including projects in the following areas:
- Substance Use Disorder (SUD) Care and the Opioid Crisis;
- Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED);
- Social Determinants of Health; and
- Primary Care Improvement and Alternative Payment Models;
- A narrower set of high-value projects and associated performance measures, aligned with federal priorities such as the CMS Meaningful Measures Framework; and
- Implementation of three new priority areas for DSRIP outcomes:
- Reducing maternal mortality;
- Children’s population health; and
- Long-term care reform.
A five-page summary is attached, and the full proposal is available here. The State is accepting comments through November 4th.