Buffalo Medicaid Waiver Hearing April 28, 2014—
SUMMARY:
The Medicaid Waiver program
was reviewed as a transformative reimbursement methodology for all healthcare
providers, to tie payments to performance on specific metrics, targeting
specifically a 25 percent decrease in unnecessary hospitalizations and
combining large numbers of healthcare and health-related and community service
providers together in Performing Provider Systems (PPSs).
Waiver money will be set
aside to help fill the gap between fee-for-service and outpatient and
results-based Medicaid payments.
The Waiver programs’ PPSs are
being viewed by state Medicaid Director Jason Helgerson as a permanent
structure for receiving future Medicaid payments and potentially also private
payer and Medicare payments. The program will stay focused on CMS’ Triple Aim
with the theme of collaboration among varying types of healthcare provider
organizations.
The state’s $8 billion
Medicaid Waiver program has three distinct parts:
- The $500 million Interim Access Assurance Fund to help stabilize critical health service providers (of this, $250 million will be dedicated to large public hospitals, and $250 million to non-public/safety net hospitals in ‘severe financial distress’ who meet state safety net definitions – see presentation slides and website for details);
- the $6.42 billion Delivery System Reform Incentive Payment Program/DSRIP; and
- $1.08 billion for health home, Long-Term Care, workforce and behavioral health redesign programs.
Regulatory relief will also be a key part of this program, to support
collaboration. State agencies such as OMRDD,
OASAS and DOH, will have the ability to waiver regulations as long as they
smooth service delivery, and achieve the program’s goals without sacrificing
patient safety, etc.
Application processes and scoring for the DSRIP
program were discussed at some length, along with deadlines for applications:
Comments on the DSRIP and Interim Access Assurance
Fund will be taken through April 29, at: 1115waivers@health.state.ny.us
The Medicaid Waiver presentation given April 28 by Mr.
Helgerson can be found at:
More detail on the comment and application processes can be
found on the state Health Department’s Waiver page, at:
http://www.health.ny.gov/health_care/medicaid/redesign/medicaid_waiver_1115.htm
And the DSRIP web page:
May 15, 2014:
Non-binding Letters of Intent (LOIs) regarding plans to participate in the
DSRIP program will due to the state Health Department.
Mid-June:
Planning Grant applications will be available from the state Health Department
and will be due approximately 30 days from their issue (mid-July). The application and a pre-scoring tool will be available
online at the DOH’s website, along with a sample ‘model application’ with
sample scoring.
December 2014: Final, formal PPS/DSRIP
applications due.
Terms and
conditions related to the Federal-State Health Reform Partnership Medicaid
Section 1115 Demonstration can be found here:
http://www.health.ny.gov/health_care/managed_care/appextension/docs/fshrp_special_and_conditions.pdf
Page 25 of the
web document relates to pertinent Medicaid delivery systems/ care providers.
Regarding the separate, Medicaid Partnership Plan
Extension program, Partnership Plan information can also be found on the state
Health Department’s website, at this address:
Partnership Plan Special Terms and Conditions can be found
here:
http://www.health.ny.gov/health_care/managed_care/appextension/partnership_plan/docs/special_terms_and_conditions.pdf
BUFFALO MEDICAID WAIVER HEARING SUMMARY, CONTINUED:
During the presentation, the
scoring mechanism and timelines for the project were discussed. Likely the
exact same or similar information given at each of these hearings.
50 SYSTEMS STATEWIDE AN ‘IDEAL’ NUMBER
At the Buffalo hearing, Dr. Gregory
Young asked how many “Performing Provider Systems/Networks” are being
considered an ideal number by DOH and Helgerson said 50. After the presentation
Helgerson elaborated to say he would not like to see quite as many as 50
provider networks (Performing Provider Systems, or PPS’) in the New York
City/Long Island area and would not like as many as 25 networks upstate. He is
hoping that the Finger Lakes area might have just one network on its
application, but allowed that it’s unlikely Western New York would have just
one network/system.
STATE OPEN TO DISCUSSION ON SOUTHERN TIER & RURAL
CHALLENGES
The challenges of the rural
areas in the Southern Tier were discussed in questions and answers. Performance
matrix scoring would be terribly skewed in areas with small numbers of Medicaid
patients and could have a seesaw effect on payments for smaller rural
providers. When confronted with the cross-border issues affecting some of our
member hospitals, he suggested that there is no prohibition against an
application including a Pennsylvania or Ohio provider — there is no requirement
that the provider be New York State-based, only that the patients addressed be
NYS residents. Therefore it is likely some out-of-state data will need to be
collected if Medicaid patients travel across state lines for care. Mr.
Helgerson is open to discussion on the difficulties of including rural hospital
providers and rural providers in general in the DSRIP portion of the Waiver.
WNYHA ROLE IDENTIFIED
He also said he is open to
including the WNY Healthcare Association as an information source for putting
together hospitals with other providers. This will have to happen soon, as the
Letter of Intent is due in May and the initial planning applications are due in
mid-June. The applications will be returned with comments by July with formal,
final applications due in December 2014. Names and numbers of providers
included in each application can be changed up until the final application, but
the sooner the list of applicants is finalized, the better, as DOH offered to
preliminarily score such applications before December.
Another potential role for
the Association is in convening groups of providers much as the NYS Partnership
for Patients does now, to address specific approaches to identified issues
being addressed successfully in one area, i.e. hospital admissions for
asthmatics.
COMMENTS WELCOME ON POTENTIAL DUPLICATE REPORTING
MECHANISMS WITH PARTNERSHIP FOR PATIENTS/OTHER MEASURES FOR HOSPITAL PERFORMANCE
Helgerson was also open to
discussion about duplicative reporting for providers and said quite pointedly
that he would ‘welcome comments’ to that effect — it was noted that the
reporting mechanism for this program is nearly identical to that for the NYS
Partnership for Patients and measures many of the same items, but could create
a double burden for providers participating in both programs.
Comments will be accepted through April 29th for the DSRIP and Safety Net programs, and through May 2nd
for the Program Plan Extension.
——
Regarding specific questions and answers:
The many non-profits
presented themselves as potential partners alongside asking their questions.
·
INSURERS NOT
EXPECTED AS LEAD APPLICANTS
·
RURAL PROVIDERS
SHOULD APPLY UNDER EXCEPTION CLAUSES IF APPROPRIATE
·
TOTAL PATIENT
POPULATION METRICS WILL BE CONSIDERED VS. MEDICAID-ONLY, FOR SOME PROGRAMS
Q-Lisa Damiani asked whether
the state was looking at Medicaid only or total population metrics for results.
A-Helgerson answered that for
Domains two and three, Medicaid and Dual eligible will be looked at
solely. For Domain 4, Population Health
will be considered, across the spectrum and reiterated that integrating
non-qualifying providers is KEY to community outreach and population health
portions of DSRIP/ the Waiver.
·
AGING OF DATA QUESTIONED BY CHS
Q-Rachel Neiss (sp-?) of
Catholic Health asked about the scoring of DSRIP applications, questioning the
rationale of a base set of data remaining as a static metric against which an
entire five-year program will be measured, meaning the data will be quite old
by the final year.
A-Helgerson acknowledged the
validity of the question but reemphasized the importance of a good application
and restated that applicants’ performance-based payments will be adjusted in
accordance with their fluctuating performance throughout the five years, so
that if they perform exceptionally well there is a possibility that they will
earn a higher payment rate.
·
REQUEST MADE FOR STATEWIDE INFORMATION-SHARING DATABASE
Q-Ruth Spink of the Genesee
County Office for Aging asked a question about Information sharing and the
potential use of a uniform assessment tool for population-based data, and asked
if some portion of the Statewide Database which her organization worked with
DOH on in an RFP, could be made accessible to all providers.
A-Helgerson said DOH expects
many participants will already be in RHIOs so they potentially have access to
patient-level data through that route, Ms. Spink said she was thinking about a
portal for providers and a Medicaid Date Warehouse.
Helgerson said it’s possible
that the state will help to reinforce the Statewide Health Information
Network/SHINY
—
·
ONE OR TWO APPLICATIONS PER GEOGRAPHIC AREA MEANS ONE
OR TWO PER LARGE COUNTY OR ONE PER TWO OR THREE SMALLER-POPULATION COUNTIES,
HELGERSON SAID
Q-Bruce Nisbet of Health Home
Partners of WNY, and one of the heads of the local SNAPCAP, asked Helgerson for
more guidance on how many DSRIP applications would be looked at per area,
referring to Helgerson’s comment earlier that there would be one or two
applications accepted per geographic area. Helgerson answered that he foresaw,
one provider group, per county, and would hope for some multi-county
applications, so one application per two or three counties.
A-He referred to the Finger
Lakes HSA and the hope that it would be possible to ‘keep the number of
applications down’ and to keep our region’s number of applications ‘very
manageable’.
·
NEWLY CREATED PROVIDER ENTITIES MIGHT BE CONSIDERED DESPITE
ABSENCE OF HISTORICAL DATA
·
ICR DATA OPEN FOR APPEALS PROCESS, HELGERSON SAID
Helgerson added that Safety
Net Institutional Cost Report Data upon which determinations are based will
also be open to an appeals process for individual institutions.
He also added that the fewer
metrics or projects taken on by an individual Patient Provider group on a
DSRIP, the more likely success could be.
·
LONG-TERM CARE WORKFORCE NEEDS SHOULD BE ADDRESSED
A-It’s important to include
Long-Term Care in a Performing Provider System/network for a DSRIP application,
Helgerson said. He pointed out that workforce retraining is a part of the
Medicaid Waiver program, and that every
application needs to have a workforce strategy.
·
PATIENT ATTRIBUTION WILL BE COMPLEX, SEPARATE WEBINAR
PROGRAM PLANNED BY DOH
**Because of the complexity
of the issue of patient attribution, DOH will hold a separate webinar on that
issue, alone: patient attribution, Helgerson said.
·
RURAL PROVIDERS SHOULD INCLUDE THEIR TERTIARY
PROVIDERS IN APPLICATIONS, HELGERSON SAID
Q-Gail Speedy of
SNAPCAP/STHCS, who has a rural FQHC, asked about standards for rural PPS’s
given the small numbers.
A-Helgerson replied that if a
provider is too small, it will be difficult to prove success on specific
metrics and these little variations based on small numbers of patients will
impact a provider system’s payments significantly under the system set up by
the state. He added that rural providers
should consider having tertiary centers included in their Performing Provider
System/network and included as part of the DSRIP discussion. He added that this complex issue may merit
more discussion regarding rural providers.
·
HOSPITAL ASSOCIATIONS SOUGHT AS PART OF INFORMATION
SHARING NETWORK FOR THIS PROCESS
—end—
No comments:
Post a Comment