NYS Files Request for Section 1115(a) Demonstration Authority

May 12, 2020

Today, the Department of Health (DOH) submitted to the Centers for Medicare and Medicaid Services a $2.75B Request for Section 1115(a) Demonstration Authority related to the COVID-19 public health emergency to: 1)  help New York respond to the COVID-19 pandemic 2)  re-purpose the infrastructure built under the state’s DSRIP program 3)  support rapid pivoting and re-configuring of aspects of the State’s health care delivery system.  The Request was just posted and is available here:


It seems the state is requesting an emergency waiver to make three key initial investments to preserve essential providers that serve as the safety net / are developing emergency response capacity in the near term:

1. Emergency Capacity Assurance;

2. Rapid Facility Conversion; and

3. Regional Coordination and Workforce Deployment to be funded through two funding pools using constructs from New York’s existing MRT Waiver with which New York providers are familiar: 

#1: Emergency Capacity Assurance Fund (ECAF) ($1.85 billion): This pool will provide direct funding to stabilize providers and ensure the ongoing availability of provider capacity during and after this public health emergency. Specifically, this funding would be directed to supporting initiatives #1: Preserving the Safety Net; 

#2: Rapid Facility Conversion. These funds will be disbursed directly to providers, as identified below, through a precise and rapid application process where providers will describe and attest Page 3 of 19 to how they intend to spend the funds within pre-set priority areas and the specific timeframe over which the funds will be spent. Unspent funds identified in provider progress reports will be reallocated to emerging needs or other providers. 

#3: Regional Coordination and Emergency Deployment Fund (RCEDF) ($900 million): This pool will fund Performing Provider Systems (“PPSs”) to support #3: Regional Coordination and Workforce Redeployment efforts. This fund will be allocated based on attribution of Medicaid lives adjusted to account for concentrations of COVID-19 cases in the region and other factors pertinent to the emergency response, as applicable. 

New York’s application includes the following elements:

Preserving the Safety Net: Emergency Capacity Assurance ($1.2B):  This is funding to support essential community providers and institutions that are facing sustainability challenges resulting from the current crisis

Rapid Facility Conversion ($650M): This is funding for investments to support rapid facility conversion at a local level to meet demand in the public health emergency

Regional Coordination and Workforce Deployment ($900M): This is funding for the state’s Performing Provider Systems (PPSs) to support regional coordination, deploy telehealth infrastructure, and expand adoption of promising practices related to the COVID-19 response.  The funding would also support workforce redeployment efforts to enhance local capacity in a public health emergency.  

The application also makes reference to a future concept paper with the goal of designing the ‘delivery system of the future’ aligned with value-based payment goalsand the lessons of COVID-19.  

If CMS approves New York’s request, the state would move rapidly to make funding available.  It would develop an application process for the Preserving the Safety Net: Emergency Capacity Assistance funding that includes published eligibility requirements. Applicants will need to rapidly turn around their submissions (10-day period).  Rapid Facility Conversion would take a similar path.  

Regional Coordination and Workforce Redeployment:  This funding ($900M) for PPSs would be made available through a fast-tracked application and approval process. All 25 PPSs across the state would be eligible to submit a regional coordination plan, and those with strong community-based organization partnerships as well as those with ‘inclusive’ provider networks would be given ‘special consideration and weighted appropriately’ in award allocations.   Half (50%) of the funding would be available upon approval of a PPS’s coordination plan, and the remaining funds would be allocated based on performance. 

This is a brief discussion of today’s new funding application to CMS from the New York Medicaid Program.  CMS must still review and determine whether to approve the state’s request.  

The NYS Council sent you the Letter from State Medicaid Director Donna Frescatore as well as New York’s application earlier today via our email on this topic.