Crain's: Movement on Waiver, but Questions Remain

NYAPRS Note: The below two articles highlight some of the movement on the state’s revision to the 1115 waiver amendment, submitted to CMS on Monday. While state officials feel optimistic about its prompt approval, significant fundamental questions remain. For example, the entities eligible to receive new federal funding must be defined by the state and vetted through a community-comment process.


Feds 'Pleased' with NYS' Revised Waiver

Crain’s Health Pulse; 12/19/13


After meeting with CMS officials on Monday, New York state has more than a glimmer of hope that the federal government will approve the state’s $10 billion Medicaid waiver request, perhaps by Dec. 31. “We’re much closer today than a month or so ago,” Medicaid Director Jason Helgerson said yesterday at a Department of Health update on the waiver.

The meeting on Monday was “very positive,” he added, with CMS “quite pleased,” which led Mr. Helgerson to feel “we are getting closer to approval.”

The revised documents that may finally win favor in Washington are online at the MRT website. The public has until Jan. 15 to make comments on the state’s revised application. Comments should be emailed

The bulk of the waiver money is directed at funding Delivery System Reform Incentive Payment projects. Through DSRIP, the state hopes to fund “substantial, transformative change for providers,” said Mr. Helgerson.

The state’s goal is to cut avoidable readmissions by 25% over five years, a “significant reduction,” said Mr. Helgerson. Over 10 years, the state hopes to halve the rate of avoidable readmissions. The DSRIP money is for hospitals, as well as long-term care and behavioral-health providers, who must choose from CMS’ list of 25 acceptable projects. The applicants must meet measures in specific areas, such as potentially preventable emergency-room-visit readmissions. The projects encourage system changes that decrease inpatient care and increase primary care.

Community-wide efforts have priority, said Mr. Helgerson. Publicly funded hospitals such as SUNY and HHC can tap the funds to “transform into highly efficient safety-net providers.”

Once the applications for DSRIP are in, they will be posted online, with the public invited to comment on which ones should get funding. The applications will be assessed by a review panel that includes experts outside state government.

Mr. Helgerson’s presentation is online here, but the webcast will not be archived for viewing.


Who’s a Safety-Net Provider?

Crain’s Health Pulse; 12/19/13


As the state Department of Health fine-tunes its $10 billion Medicaid waiver request (see box), health care advocates are organizing an effort to define what constitutes a safety-net provider. The major funding from the waiver, about $7.375 billion over five years, is for safety-net providers awarded Delivery System Reform Incentive Payment projects. Medicaid Director Jason Helgerson said the state still needs a clear definition of safety-net providers and is discussing the issue with CMS. Judy Wessler, former executive director of the Commission on the Public’s Health System, recently emailed other advocates that “the hospital associations are currently working on a definition for safety net, which could mean ... that the safety net will be so broadly defined that it will be meaningless. In past waivers, there has been questionable funding, so this needs to be tight.” She urged support for a definition primarily based on a bill (A.7480) proposed during the last Assembly session. The language requires at least 50% of patients are on Medicaid, dual-eligible or uninsured; at least 40% of inpatient treatment is Medicaid or uninsured; at least 3% of costs are attributed to the care of the uninsured; and care for the uninsured includes dental, prenatal and other services.