DSRIP Weekly Update-Oct. 21, 2014

Perhaps the most critical news this week for members is not new, but rather a reminder to be thinking about how your capital and regulatory flexibility needs are brought to the table in discussions among your Performing Provider Systems (PPSs). It is critical that those discussions happen now so that the necessary concepts are included in the December application. To gain insight into the application process and what is expected of participants, it is worth reviewing the Draft Project Plan Application Resources. Like every other week, there is new news too, such as the further extension of the application deadline for the Vital Access Provider Exemption, and a new DSRIP director.

Vital Access Provider Exception Deadline Extended Again

The deadline for the Vital Access Provider (VAP) Exception applications has been extended again, and is now 5 p.m., Oct. 24, 2014. The Department of Health (DOH) reports that the extension was provided as a response to numerous concerns and the need for further instructions. DOH has created VAP Exception forms specifically for the HCBS/1915i service providers and the State designated Health Homes and Downstream Care Management Agencies. The revised forms can be accessed here. Note that if you already completed and submitted a VAP Exception form, you do not have to complete a revised form.

The VAP Exception appeal process is open to other Medicaid providers, physicians and pharmacies that did not qualify for the Safety Net definition. If the exception is granted, then the applicant will be qualified and can fully participate in the DSRIP program. Members should consider the first of the three categories that a Medicaid provider or organization may appeal for a VAP exception to ensure every opportunity to be deemed as a Safety Net Provider:

A community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.
Any hospital is uniquely qualified to serve based on services provided, financial viability, relationships within the community, and/or clear track record of success in reducing avoidable hospital use.
Any state-designated health home or group of health homes.

Remember that providers that are not deemed as Safety Net providers can still participate in DSRIP PPSs, but may only receive up to five percent (as a group) of their Performing Provider System's (PPS’s) award. Click here for more information.

Lastly, DOH is also working to update the website to provide a section containing the approved Safety Net Exception entities and a second section containing those pending approval, which will provide insight regarding where your organization stands in this process.

Questions for DOH regarding the VAP Exception or Safety Net process should be sent to BVAPR@health.ny.gov.

Peggy Chan Announced as DSRIP Director

DOH announced the selection of Peggy Chan for the position of DSRIP Director in DOH’s Office of Health Insurance Programs (OHIP). According to the announcement, Ms. Chan previously worked for the New York Presbyterian Hospital as the Director of the Office of Care Management, Community Health. She has over 25 years of experience in the health care field and an extensive background in health plan operations and care management. She begins in this new role at OHIP this week.

Reminder of Public Comment Opportunities

As a reminder, there are a variety of opportunities to help shape aspects of DSRIP through public comment. Below is a summary of current opportunities. We encourage members to copy us on any comments so that we may include them in our advocacy as well.

Draft Project Plan Application Resources: A webinar and information regarding the draft DSRIP Draft Project Plan Application, which PPSs will submit in December 2014, is available here. We recommend that members review the resources because DOH will be accepting public comments by email until Oct. 29, 2014 at dsripapp@health.ny.gov.

DSRIP Measure Specification and Reporting Manual: The DSRIP Measure Specification and Reporting Manual has been posted on the DOH DSRIP website here. The manual contains information about the measures required for the DSRIP projects, the reporting mechanisms, timeframes, and performance goals and the methods used to establish annual improvement targets and determining high performance. DOH will accept comments by email until Nov. 10, 2014 at dsripapp@health.ny.gov.

Regulatory Reform

We want to remind members that DSRIP provides the opportunity to request waivers of state and federal regulation and statute. LeadingAge NY provided DOH with initial suggestions and encourages members to be engaged with their PPSs about other ways in which such waivers would help promote DSRIP objectives. Please let us know what sorts of waivers you are considering and how we can assist you in developing the request. Click here for more information about this opportunity.

Capital Restructuring Program Funding

As a reminder, any members hoping to access capital funds through DSRIP should be talking now with the PPS leads and partners to help ensure it is included in the final application in December. We are also working to ensure that some of these funds are available outside of the DSRIP process, as the statutory language specifies. The $1.2 billion in funding is meant to support capital projects that help strengthen and promote access to essential health services, including projects that will improve infrastructure, promote integrated health systems and support the development of additional primary care capacity. Click here for more information about this opportunity.

LeadingAge NY is committed to helping our members succeed in DSRIP projects in the context of a rapidly changing health care landscape. Don't hesitate to reach out to us if we can be of help or support. Questions for DOH can be directed to DSRIP@health.ny.gov.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828