CMS Awards New York $598m to Create Greater Access to Long-Term Services, Supports

CMS Awards New York $598m to Create Greater Access to Long-Term Services, Supports

NYAPRS Note: The following are taken from CMS’ materials found at

  • The Centers for Medicare & Medicaid Services (CMS) has awarded New York the State Balancing Incentive Payment Program grant under Section 10202 of the Affordable Care Act (hereafter referred to as the "Balancing Incentive Program.")
  • The Balancing Incentive Program provides a strong financial incentive to stimulate greater access to non-institutionally based long-term services and supports (LTSS.)
  • The period of performance for this grant award is April 1, 2013 through September 30, 2015. New York will receive an enhanced match rate of 2% for non-institutional LTSS.
  • The award is $598.7 million which is based upon your projected expenditures and is dependent on the actual amount spent on non-institutional LTSS and the implementation of the required structural changes.



The state shall implement, no later than September 30, 1915, the three structural changes required by the statute: No Wrong Door/Single Entry point system, conflict-free case management, and a core standardized assessment instrument...The state may not target specific populations in the implementation of the structural changes - these systems must be available to all populations receiving long-term care services and supports (LTSS) within the state by the end of the program period.

Community-based LTSS Spending Targets

The state shall achieve, no later than September 30, 2015, the spending targets outlined by the authorizing statute. The state is to achieve a minimum of 50% of the total LTSS spending in non-institutional (home and community-based) settings. Total LTSS spending is the sum of institutionally-based long-term services and supports and all non-institutionally-based long-term services and supports, as set forth in section

10202(f)(1) of the Affordable Care Act.

Balancing Incentive Program Funding

The state will receive a 2% enhanced FMAP on all community-based LTSS identified by CMS. The enhanced FMAP is payable to the state on a quarterly basis through the end of the program period on September 30,2015, or when the entire $3B appropriation has been expended, whichever occurs soonest. This use of this enhanced funding should meet the following criteria:

1. Must be used to provide increased offerings of or access to non-institutional long-term services and supports;

2. Must be used for the benefit of Medicaid recipients; and,

3. Must not be a prohibited use of Medicaid funding.


1. Developmental Disability Health Programs Transformation. Beginning April 1, 2013, in conjunction with the state's Money Follows the Person (MFP) Operational Protocol (OP) and Balancing Incentive Program, CMS will provide federal support related to designated state health programs in OPWDD, OMH and OASAS for the state's efforts to reform its developmental disability system. In order to receive federal support for ID/DD transformation the state must provide the following deliverables:

a) Money Follows the Person Protocol. By April 1, 2013, New York will have submitted and received approval for an amendment to the MFP Operational Protocol adding the ID/DD population for transition

2. Balancing Incentive Program Work Plan. The state will submit a detailed structural change work plan to implement the Balancing Incentive Program no later than September 1,2013. The work plan will meet all CMS requirements: Conflict-free case management, No Wrong Door/Single Entry Point System and Core Standardized Assessment Instruments.. The state will develop the structural change work plan in the format provided by CMS and includes the state's transformational activities, target dates, and deliverables.

3. Balancing Incentive Program and Money Follows the Person Infrastructure Alignment. Align the infrastructure requirements for the Balancing Incentive

Program and MFP, including reaching the Balancing Incentive Program target expenditure benchmark of 50 percent across all Medicaid LTSS expenditures by September 30, 2015.

Conflict-free case management. NY's strategies to mitigate conflict through the Care Management for All Program are aligned with the Balancing Incentive Program conflict-free case management guidance. Conflict-free strategies include the ID/DD service coordination activities

4. Use of Balancing Incentive Program enhanced FMAP. No later than April 15, 2013, submit the following information to Effie George, CMS Project Officer:

a) Provide a description of specific identified gaps and issues for which the state is prepared to utilize enhanced FMAP across all target populations (e.g., elderly, ID/DD population, people with mental health issues, and people with physical disabilities).

b) The NY State Rebalancing Activities provides detailed information on the activities and funding sources needed to address identified infrastructure gaps. Provide a revised document with corresponding budget estimates for proposed rebalancing activities that identifies distinct funding sources and differentiates which funding source and amount funds each activity.

In its February applications letter to CMS, New York proposed the following plan:

To achieve these goals, New York will work to implement the three structural changes required under BIP, which will provide additional tools to streamline the LTSS eligibility and assessment process in New York. To meet these requirements, specifically, the State will:

  • No Wrong Door/Single Entry Point (NWD/SEP): Enhance the existing NY Connects Network, which is currently operational in 54 Counties and serves as an information and assistance system for long term care services.
  • Core Standardized Assessment Instrument: Continue implementation of the Uniform Assessment System (UAS-NY) and align with other agencies to ensure compliance with the core data set.
  • Conflict-Free Case Management Services: Remediate any case management arrangements that do not align with the principles of BIP.

New York’s Uniform Assessment System (UAS-NY) for older adults and/or physically disabled individuals is being phased-in beginning the first quarter of 2013 and is planned to be implemented by the end of 2014. The New York State Office for People with Developmental Disabilities (OPWDD) is also implementing a new assessment system that uses the same core data set and will be in its final phased by the end of the BIP project funding period. New York will review other assessments to ensure compliance with the required domains and other elements of BIP.

The BIP implementation plan is to investigate integrating an automated initial screen or self-assessment into the NY Connects system of NWD/SEP. This phase of BIP implementation is expected to be complete by the end of 2014. During the funding period New York State will carefully review its assessment and care planning processes to eliminate potential conflicts with BIP goals related to case management. As “Care Management for All” is implemented, New York will ensure that consumers have meaningful choice of providers, the opportunity to change care plans if dissatisfied and a fair, centralized appeals process to minimize any conflict of interest.

New York will use its increased federal funds to continue its successful rebalancing efforts to date including, but not limited to, the following:

1. Transitioning and diverting individuals who are elderly and/or disabled from institutional to community based settings;

2. Increasing community based opportunities for those with behavioral and intellectual disabilities;

3. Developing additional housing options to support high need/high cost Medicaid recipients in stable, sustainable and safe community environments; and

4. Expanding opportunities to address those needs which are critical to remaining in the community.