More on NYS 1115 Waiver Proposal

September 14, 2022

Last week we sent you a brief, bulleted list of 6 takeaways from our quick review of the revised and recently submitted (to CMS) NYS 1115 Waiver proposal.  Our list highlighted the obvious changes we saw between the July and September versions of the Proposal.  Specifically, we pointed out changes that (based on the formal comments we submitted in May – attached) has our fingerprints on them.

As a reminder, here’s the bulleted list we sent you on September 8:

  • We requested that people with lived experience in the behavioral healthcare delivery system be included in HERO governance positions.  Waiver proposal includes this important element.  
  • Along with the BHCCs/IPAs, the NYS Council has been fighting for years to ensure providers have access to data from the state and health plans.  Waiver proposal takes the data sharing role away from plans. State will share the data with providers. 
  • We asked that the statewide referral network be provided by local nonprofits. The state chose SHIN-NY.  (Note: We did not request it be SHIN-NY specifically – we just made a general request re: local nonprofits) 
  • A longstanding advocacy effort finally pays off in this proposal by expanding the populations eligible for pre-release Medicaid services.  (more below) 
  • NYS Council has repeatedly prioritized and the Waiver proposal responds with the state committing to pay specific attention to VBP arrangements for people with significant BH needs
  • NYS Council has fought to ensure that the waiver proposal includes addition of BH sector as eligible for Workforce Recruitment and Retention funds.  

Next, here’s more information from the final waiver proposal regarding some of the bulleted items listed above: 

HEROs:  The Waiver application now specifies that the HERO must have or establish a governing body, representative of each constituent group to include: children and families with complex needs, and consumers with lived experience including SMI, SMD, physical, intellectual and developmental disabilities.

SDH Networks:  Additional funds are allocated ($69M) for Social Determinant of Health Networks.  Funding will now be $92.5M in year one, and $185M in each of the subsequent years, for a total investment of $860M.

VBP:  The VBP Incentive Pool will use a fee schedule to pay CBOs.  

Health Equity Definition:  Includes the Robert Wood Johnson Foundation definition of health equity:   Everyone has a fair and just opportunity to be as healthy as possible, which requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness, and lack of access to good jobs, with fair pay, quality education and housing, safe environments, and health care.

Health Equity VBP:  The application now includes examples of health-equity VBP to include models for individuals with significant behavioral health conditions.

Populations Eligible for pre-release services:   The final proposal expands the health conditions for criminal-justice involved populations to qualify for pre-release services.   Effort will now include targeted Medicaid services to individuals with two or more qualifying conditions of either HepC, HIV/AIDs, sickle cell disease, a serious mental illness, I/DD, or a substance use disorder, who are incarcerated, and 30 days prior to release.  Services will include care management and discharge planning, clinical consult services, peer services and medication management.  

Workforce Funds: -Added behavioral health providers and providers serving high-needs children to the list of providers that may be included in investments for workforce recruiting and retention;-Clarified that recruitment and retention initiatives will include a focus on LGBTQ+ and workers that reflect that community.

Digital Health/Telehealth:  Proposal included examples of virtual care support focused on children’s behavioral health and children and families with complex needs. 

Evaluation:   Reduced waiver evaluation goals to one main there: reduce health disparities, advance health equity, and support the delivery of social care