DOH Submits Formal DSRIP Waiver Extension Proposal to CMS

December 9, 2019

The New York State Department of Health (DOH) last week sent a formal Delivery System Reform Incentive Payment (DSRIP) program extension request to the Centers for Medicare & Medicaid Services (CMS). Under the current Medicaid 1115 waiver, DSRIP ends on March 31, 2020.

DOH has requested $8 billion over a four-year period and has structured the program into two phases. Phase 1 is a Waiver Extension for the period April 1, 2020 to March 31, 2021. This phase largely continues existing performing provider system (PPS) structures and efforts, and focuses on continued implementation of promising practices that PPSs identified as significant to reducing avoidable hospital utilization. Phase 1 funding would use unspent DSRIP funds which the State estimated to be around $625 million.

Phase 2 is a Waiver Renewal for the period April 1, 2021 to March 31, 2024. For this phase, DOH proposes creating two new structures, Value Management Organizations (VMOs) and Social Determinants of Health Networks (SDHNs). VMOs will comprise managed care organizations (MCOs), providers of all types, Qualified Entities, SDHNs, and other care management stakeholders, including local departments of health. VMOs could be led by a PPS, a PPS subset, or a new legal entity capable of contracting with and receiving funding from the State.

SDHNs will be regional entities created to organize community-based organizations into networks and link social interventions to delivery system transformation and value-based payment activities. DOH will directly fund SDHNs for capacity building, with additional funding flowing through an MCO value-based payment incentive pool and provider partner contracts.

Phase 2 also includes funding for an additional round of the Interim Access Assurance Fund, which funds qualifying safety net hospitals. DOH also proposed funding for continued workforce investments. Phase 2 will include additional high-priority areas, including children’s health, maternal mortality, and long term care.

GNYHA will continue monitoring DOH’s waiver renewal activities over the next several months.