NYS Federal-State Health Reform Partnership (F-SHRP) Waiver Phase-Out Plan

Background

The Phase Out Plan for the F-SHRP waiver, required by the Special Terms and Conditions (STCs), explains the transition of the populations currently covered by F-SHRP into the Partnership Plan waiver, the possible transition from F-SHRP to the Partnership Plan of Designated State Health Programs (DSHPs) that are matched with federal dollars, the treatment of 12-month continuous eligibility, and the closeout costs associated with terminating the demonstration.

The current F-SHRP populations consist of certain parent and child eligibility groups in 14 upstate counties that are mandated to enroll in Mainstream Managed Care (MMMC), aged and disabled eligiblity groups required to enroll in MMMC, and eligibility groups required to enroll in Managed Long Term Care (MLTC). These populations will be transitioned into the New York State’s Partnership Plan Medicaid Section 1115 Demonstration (11-W-00114/2). According to the phase-out plan,"[o]nce transitioned, the eligibility and benefits for these populations will be equal to those afforded them while under the F-SHRP Demonstration."

Overview of F-SHRP

The overall intent of F-SHRP was "to improve the economy, efficiency and quality of care, by requiring families and children to enroll in managed care [plans]." It continued to evolve with the shift from institutional to community-based care and the advantages to be gained through health information technology. In 2005, it incorporated the HEAL NY program, and in 2012, it added mandatory enrollment in MLTC plans. The F-SHRP waiver was set to expire in 2011, but DOH was granted a two-year extension until March 2014.

Independent Assessment Provision

The transition of MLTC populations from the F-SHRP to the Partnership Plan includes a proposal on page 6 "to develop an independent entity to conduct distinct clinical assessments that is currently part of the MLTC plans' enrollment and assessment life cycles." This proposal is framed as "part of recent amendments to the STCs" and a mechanism "to assure consumers appropriate access to community based long term care."

LeadingAge NY has contacted the DOH to seek clarification of this provision. We will keep members informed as soon as any information becomes available.

The phase-out plan was published for public comment. For instructions on submitting comments, click here and see Attachment 5. Comments are due before Friday, Nov. 22.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871