NOTES and LINKS: NEW YORK'S MEDICAID WAIVER PROGRAM:

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.

The Medicaid Waiver presentation given April 28 by Mr. Helgerson can be found at:

http://www.health.ny.gov/health_care/medicaid/redesign/docs/waiver_amendment_update_present.pdf

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:

http://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

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:

http://www.health.ny.gov/health_care/managed_care/appextension/

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