NYS Council 1115 Waiver Hearing Summary & Resources

June 27, 2019


Earlier this week, the NYS Department of Health (DOH) held a public hearing where stakeholders from across the state could share their thoughts regarding the many programs/initiatives authorized under New York’s 1115 waiver, sometimes referred to as the ‘Medicaid Redesign Team (MRT) Waiver’.

More About the Waiver

  • The 1115 waiver, also known as the MRT waiver in New York State, is an agreement between the federal Centers for Medicare and Medicaid Services (CMS) and New York State that allows the State to use a managed care delivery system to deliver benefits to Medicaid members, create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance.
  • The MRT waiver is a vehicle by which the State has implemented the initiatives of the MRT and subsequent health systems reforms, including the DSRIP program.
  • In addition, New York’s goals in implementing its MRT waiver include improving access to health services and achieving better health outcomes for New Yorkers through multiple programs.

The hearing was hosted by State Medicaid Director Donna Frescatore, Greg Allen and Peggy Chan from DOH.  The vast majority of speakers represented DSRIP PPS lead organizations who spoke of the critical need to continue the DSRIP Program.   (New York State is preparing to apply to CMS for an extension of the current DSRIP Program –  DSRIP 2.0, if you will).

I spoke to the importance of changing the rules of the DSRIP game so that community-based organizations can have far more influence in the PPS decision-making process and enjoy more of the rewards associated with successful DSRIP Projects.  I gave statistics regarding the pitifully small amount of PPS funds that had flowed to community based organizations as of 11/18. I also addressed the problems we continue to have with MCOs regarding timely and full payment of claims as the carve-in continues.  I made recommendations for how the state should amend and update the state’s Model Contract that governs the carve in of our population.  Finally, I raised our concerns regarding the many significant barriers our BHCCs and IPAs continue to face as they seek value based contracts with MCOs.  We believe the state has the ability to change this situation.  As you know, the NYS Council has led the charge to advance the BHCC-IPA agenda but as yet the state has failed to remove the barriers that preclude these entities from contracting with MCOs.

A written summary of my comments are online here.

Also a Power Point presentation was provided to the members of the DSRIP Project Assessment Workgroup (PAOP) that oversees DSRIP project implementation and reviews outcomes.   CHECK OUT PAGES 17 – 23 for a look at PPS performance outcomes associated with DSRIP projects focused on mental health and substance use disorder care.

In addition, a second presentation was shared with members of the DSRIP PAOP during a day long meeting held in Albany earlier this week that included a public hearing on the state’s 1115 waiver (topic of an earlier email from us).  Note on slide 12 the state’s timeline for the DSRIP Renewal submission process.