NYAPRS Note: The state continues to meet with stakeholders across the healthcare spectrum to discuss the implications of the 1115 waiver. Though managed care companies are not specifically involved in the framework of DSRIP, they are necessary partners for the ultimate shift of the delivery system to value-based networking. Over time, the transition to managed care and DSRIP implementation, as well as other historic realignments in NY like Regional Centers of Excellence, will all align together. For example, community needs assessments for DSRIP will help MCOs target program development and assist RCEs to determine locations for interventions; project planning funds to ready safety net providers for DSRIP will help boost infrastructure and contracting capacity in preparation for managed care contracting; and psychiatric hospitals faced with restructuring can now have partners through DSRIP to help diversify services and shift to value-oriented care. Learn more about DSRIP and how the state envisions its integration into ongoing policy developments on the MRT website, and in particular DOH’s recently released FAQ page.
DSRIP and Insurers
Crain’s Health Pulse; 5/13/2014
The New York State Health Plan Association hosted a meeting last week for insurers to meet with the Department of Health about the Delivery System Reform Incentive Payment program. Insurers were given an overview of the new Medicaid waiver’s goal of having 90% of provider payments based on value-based methodologies over time. DOH outlined its plan to implement a state managed-care contracting plan with new payment policies. That plan will begin in the late summer or early fall of 2014, according to HPA. It must first be submitted to CMS prior to the state’s submission of contracts and rates for approval for the 2015-16 contract cycle, and must be approved before any federal funds flow to health plans. Insurers told DOH they want to be involved in the development of alternative payment methodologies used by the new Performing Provider Systems, which is fine with DOH, said HPA.