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PER
FOR
MIN
G P
RO
VID
ER S
YST
EM
DEV
ELO
PM
ENT
LIFE
CYC
LE:
AN
ILLU
STR
ATI
VE
EXA
MP
LE
oH
osp
ital
A s
enio
r le
ader
ship
has
att
end
ed a
sem
inar
on
DSR
IP a
nd
h
ave
dec
ided
to
par
tici
pat
e. L
ead
ersh
ip r
evie
wed
th
e p
rogr
am
do
cum
ents
ava
ilab
le o
n t
he
DSR
IP w
ebsi
te.
oH
osp
ital
A is
elig
ible
to
lead
a D
SRIP
pro
ject
sin
ce it
qu
alif
ies
as a
D
SRIP
saf
ety-
net
pro
vid
er; a
nd
H
as
pa
st a
dm
inis
tra
tive
exp
erti
se w
ork
ing
on
co
llab
ora
tive
h
ealt
h p
art
ner
ship
s
Is
in a
po
siti
on
to
pa
ss t
he
DSR
IP le
ad
pro
vid
er f
ina
nci
al
ass
essm
ent.
DSR
IP S
CEN
AR
IO:
PR
ESEN
T D
AY
NEW
YO
RK
2
Ho
spit
al A
ide
nti
fie
d it
s cu
rre
nt
issu
es
as t
he
fo
llow
ing:
oEx
cess
ho
spit
al b
eds
wit
h a
n o
ccu
pan
cy r
ate
of
70
% b
ut
staf
fin
g fo
r 9
0%
du
e to
ser
vice
mal
dis
trib
uti
on
;
oIn
effi
cien
t h
osp
ital
pu
rch
asin
g sy
stem
s –
e.g.
, eac
h o
rth
op
edic
MD
u
ses
dif
fere
nt
join
t im
pla
nts
;
o5
0%
of
ED v
isit
s ar
e fo
r p
rim
ary
care
sen
siti
ve d
iagn
ose
s re
sult
ing
in
exce
ssiv
e ED
wai
t ti
mes
. Pa
tien
ts s
tate
th
ey a
re n
ot
able
to
ob
tain
p
rim
ary
care
ap
po
intm
ents
;
o3
0 d
ay r
ead
mis
sio
n r
ates
fro
m S
kille
d N
urs
ing
Faci
litie
s (S
NFs
) is
tw
ice
stat
e av
erag
e.
DSR
IP S
CEN
AR
IO:
PR
ESEN
T D
AY
NEW
YO
RK
3
As
an
AC
A r
equ
irem
ent,
Ho
spit
al A
alr
ead
y h
as
curr
ent
da
ta t
o u
se f
or
an
init
ial
com
mu
nit
y a
sses
smen
t.
oW
hile
th
ere
are
suff
icie
nt
pri
mar
y ca
re s
ervi
ces
for
com
mer
cial
ly a
nd
Med
icar
e in
sure
d p
atie
nts
, th
ere
is s
ign
ific
ant
un
met
nee
d fo
r M
edic
aid
rec
ipie
nts
.
oM
ost
Med
icai
d r
ecip
ien
ts a
re s
een
in t
he
loca
l FQ
HC
s an
d t
he
pri
mar
y ca
re
resi
den
cy p
ract
ices
in t
he
ho
spit
al.
The
latt
er s
om
etim
es le
ads
to d
isco
nti
nu
ity
in
care
. Th
ere
are
als
o 2
ru
ral h
ealt
h c
linic
s w
ith
lim
ited
ho
urs
se
rvin
g tw
o d
iffe
ren
t ru
ral a
reas
. Th
ese
pat
ien
ts d
isp
rop
ort
ion
ally
use
th
e Em
erge
ncy
Ro
om
du
e to
th
ese
limit
ed h
ou
rs.
oZi
p c
od
e an
alys
is h
as id
enti
fied
th
e ke
y p
op
ula
tio
n c
ente
rs fo
r p
ers
on
s w
ith
av
oid
able
ho
spit
al u
se.
oTw
o lo
cal S
kille
d N
urs
ing
Faci
litie
s ar
e re
spo
nsi
ble
for
70
% o
f av
oid
able
re
adm
issi
on
s.
HO
SPIT
AL
A:
AC
A C
OM
MU
NIT
Y A
SSES
SMEN
T
4
oO
be
sity
, dia
bet
es a
nd
car
dio
vasc
ula
r d
iso
rder
s ar
e th
e m
ost
co
mm
on
se
rio
us
he
alth
co
nd
itio
ns
in t
he
adu
lt M
edic
aid
po
pu
lati
on
. Ast
hm
a is
th
e
mo
st c
om
mo
n r
easo
n f
or
avo
idab
le E
D u
se f
or
child
ren
in t
hat
po
pu
lati
on
.
oTh
e so
cial
det
erm
inan
ts o
f h
ealt
h is
a s
erio
us
issu
e fo
r H
osp
ital
A’s
pat
ien
t p
op
ula
tio
n:
oTh
e h
osp
ital
has
a n
um
ber
of
chro
nic
ally
ho
mel
ess
sub
stan
ce a
bu
se
dep
en
den
t p
erso
ns
wh
o c
ycle
fre
qu
en
tly
thro
ugh
th
eir
faci
lity.
oTh
ere
is in
suff
icie
nt
sup
po
rtiv
e h
ou
sin
g to
ser
ve t
his
po
pu
lati
on
.
oD
isp
arit
ies
bas
ed o
n r
ace,
eth
nic
ity
and
inco
me
are
pre
sen
t w
ith
in t
he
com
mu
nit
y an
d n
eed
to
be
add
ress
ed.
oEl
ectr
on
ic c
on
nec
tivi
ty t
o t
he
RH
IO a
nd
use
of
EHR
s ar
e u
nd
eru
tiliz
ed.
HO
SPIT
AL
A:
AC
A C
OM
MU
NIT
Y A
SSES
SMEN
T
5
PAR
TNER
ID
ENTI
FIC
ATI
ON
& D
SRIP
LET
TER
OF
INTE
NT
oB
ased
on
th
e id
enti
fied
nee
ds,
Ho
spit
al A
iden
tifi
es in
itia
l co
mm
un
ity
par
tner
s in
clu
din
g an
ou
tlyi
ng
smal
l saf
ety
net
ho
spit
al,
3 F
QH
C, a
larg
e m
ixed
ph
ysic
ian
pra
ctic
e, 2
Hea
lth
Ho
mes
, 2 R
ura
l C
linic
s, 2
Ski
lled
Nu
rsin
g Fa
cilit
ies,
an
d 1
CB
O.
oTh
e en
titi
es a
gree
in p
rin
cip
le t
o f
orm
th
e H
ealt
h P
artn
ers
Init
iati
ve
(HP
I) in
ser
vice
reg
ion
wh
ich
co
vers
a f
ew c
ou
nti
es.
Du
e to
its
adm
inis
trat
ive
exp
erie
nce
in p
rio
r p
artn
ersh
ip p
rogr
ams,
Ho
spit
al A
w
ill b
e th
e le
ad e
nti
ty in
th
e em
ergi
ng
Perf
orm
ing
Pro
vid
er S
yste
m
(PP
S).
oA
no
n-b
ind
ing
lett
er o
f in
ten
t fo
r a
DSR
IP P
roje
ct D
esig
n G
ran
t
app
licat
ion
is s
ub
mit
ted
to
th
e st
ate
by
May
15
, 20
14
.
6
HP
I DES
IGN
GR
AN
T A
PP
LIC
ATI
ON
: FI
RST
STE
PS
oD
iscu
ssio
ns
iden
tify
th
e n
eed
to
incl
ud
e co
mm
un
ity
par
tner
s,
spec
ific
ally
, al
tern
ativ
e/su
pp
ort
ive
ho
usi
ng,
Co
mm
un
ity
Foo
d
Pro
ject
s, a
nd
Co
un
ty H
ealt
h D
epar
tmen
ts.
oTh
e se
rvic
e ar
ea f
or
the
PP
S w
as a
gree
d t
o b
e th
e m
ult
i-co
un
ty
regi
on
ser
ved
by
the
par
tner
s.
oTh
ere
are
10
0,0
00
to
tal M
edic
aid
rec
ipie
nts
wit
hin
th
is r
egio
n t
hat
HP
I bel
ieve
s ca
n b
e at
trib
ute
d t
o t
he
emer
gin
g P
PS.
7
SAFE
TY N
ET P
RO
VID
ER S
TATU
S O
F IN
ITIA
LH
PI P
AR
TNER
S
Safe
ty N
et P
rovi
de
rs:
Ho
spit
al A
O
utl
yin
g sm
all s
afet
y n
et h
osp
ital
3 F
QH
Cs
2
Ru
ral H
ealt
h C
linic
s
2 H
ealt
h H
om
es
2
SN
Fs
C
ou
nty
Pu
blic
Hea
lth
Dep
artm
ent
(th
rou
gh c
linic
s)
No
n-s
afet
y N
et P
rovi
de
rs:
Larg
e M
ixed
Ph
ysic
ian
Pra
ctic
e
Sup
po
rtiv
e H
ou
sin
g
Co
mm
un
ity
Foo
d P
roje
ct(C
BO
)
8
STR
UC
TUR
ING
A P
ERFO
RM
ING
PR
OV
IDER
SY
STEM
Ther
e is
no
sin
gle
form
ula
fo
r a
succ
essf
ul P
PS…
..so
HP
I res
earc
hed
d
iffe
ren
t ap
pro
ach
es
(ID
S, IP
A, M
SGP,
PH
O, e
tc.)
HP
I mem
ber
s sp
ent
sign
ific
ant
tim
e tr
yin
g to
un
der
stan
d t
he
follo
win
g as
th
ey d
ecid
ed w
hic
h s
tru
ctu
re b
est
fit
thei
r P
PS:
(i
) fo
rmin
g th
e n
ece
ssar
y re
lati
on
ship
s/p
artn
ers
hip
s;
(i
i) a
chie
vin
g th
e n
ece
ssar
y le
vel o
f in
tegr
atio
n;
(i
ii) g
ove
rnan
ce;
(i
v) d
ata
colle
ctio
n a
nd
an
alys
is;
and
(v
) p
aym
en
ts a
nd
ince
nti
ves.
9
HP
I GO
VER
NA
NC
E
The
par
tne
rs a
gre
e t
hat
th
e in
itia
l str
uct
ure
of
HP
I will
be
a s
har
ed
go
vern
ance
mo
de
l wit
h e
ach
par
tne
r h
avin
g a
me
mb
er
on
th
e B
oar
d
of
Dir
ect
ors
.
Th
e sh
ared
go
vern
ance
allo
ws
no
t o
nly
fo
r th
e P
PS
to m
ain
tain
re
pre
sen
tati
ven
ess
of
par
tici
pat
ing
pro
vid
ers,
bu
t al
so
rep
rese
nta
tive
nes
s o
f th
e co
mm
un
ity
as t
he
colle
ctio
n o
f p
rovi
der
s w
as a
ref
lect
ion
of
the
com
mu
nit
y n
eed
s as
sess
men
t.
H
PI a
lso
un
der
sto
od
th
at a
su
cces
sfu
l par
tner
ship
s in
DSR
IP is
no
t ju
st a
bo
ut
the
size
of
the
pro
vid
er o
r at
trib
uti
on
tie
d t
o a
ny
on
e p
artn
er; b
ut
rath
er, t
he
cum
ula
tive
ski
lls p
oss
esse
d b
y th
e te
am t
o
red
uce
avo
idab
le h
osp
ital
izat
ion
s
10
HP
I GO
VER
NA
NC
Eo
Ho
spit
al A
, as
the
lead
of
the
emer
gin
g P
PS,
will
ser
ve a
s ch
air
of
the
Bo
ard
.
oA
rtic
les
of
Inco
rpo
rati
on
wer
e fi
led
wit
h t
he
stat
e; H
PI b
ylaw
s w
ere
crea
ted
.
oM
OU
s ar
e si
gned
incl
ud
ing
Bu
sin
ess
Ass
oci
ate
Agr
eem
ents
(B
AA
s)
to e
nsu
re a
ll co
nfi
den
tial
ity
req
uir
emen
ts a
re m
et.
oH
PI h
as a
lso
dec
ided
to
ap
ply
fo
r a
Cer
tifi
cate
of
Pu
blic
Ad
van
tage
(C
OPA
) th
rou
gh t
he
DSR
IP P
roje
ct P
lan
ap
plic
atio
n a
s H
PI h
as
bro
ugh
t to
geth
er m
ost
of
the
larg
er h
ealt
h p
rovi
der
s in
th
eir
serv
ice
area
an
d w
ant
to m
ake
sure
th
at it
has
pro
tect
ion
fro
m a
nti
-tr
ust
issu
es t
hat
may
ari
se f
rom
th
e P
PS
par
tner
ship
.
11
HP
I PR
OJE
CT
DES
IGN
GR
AN
T A
PP
LIC
ATI
ON
: P
RO
JEC
T SE
LEC
TIO
N*
oB
ased
up
on
th
e in
itia
l dis
cuss
ion
s th
e fo
rmin
g P
PS
cho
se t
he
follo
win
g p
roje
cts:
oD
om
ain
2: (
Go
al: T
o c
reat
e in
tegr
ated
del
iver
y sy
stem
an
d a
dd
ress
h
igh
rea
dm
issi
on
fro
m S
kille
d N
urs
ing
Faci
lity)
;
o2
.a.i
Cre
ate
Inte
grat
ed D
eliv
ery
Syst
ems
that
are
fo
cuse
d o
n
Evid
ence
Bas
ed M
edic
ine
/ Po
pu
lati
on
Hea
lth
Man
agem
ent;
o2
.a.iv
Cre
ate
a m
edic
al v
illag
e u
sin
g ex
isti
ng
ho
spit
al in
fras
tru
ctu
re;
o2
.b.v
Car
e tr
ansi
tio
ns
inte
rven
tio
n f
or
skill
ed n
urs
ing
faci
lity
resi
den
ts.
12
*No
te: T
his
is H
PI’s
init
ialp
roje
ct li
st a
nd
is s
ub
ject
to
ch
an
ge
as f
urt
he
r an
alys
is a
nd
dis
cuss
ion
s p
rogr
ess
du
rin
g th
e p
lan
nin
g p
roce
ss.
HP
I PR
OJE
CT
DES
IGN
GR
AN
T A
PP
LIC
ATI
ON
: P
RO
JEC
T SE
LEC
TIO
N*
(CO
NTI
NU
ED)
oD
om
ain
3: (
Go
al: T
o a
dd
ress
hig
h v
olu
me
of
inp
atie
nt
adm
issi
on
s d
ue
to c
hro
nic
d
isea
se a
nd
ast
hm
a as
wel
l as
the
nee
ds
of
the
chro
nic
ally
ho
mel
ess
po
pu
lati
on
th
at h
ave
sign
ific
ant
beh
avio
ral h
ealt
h c
hal
len
ges)
.
o3
.a.i
Inte
grat
ion
of
pri
mar
y ca
re s
ervi
ces
and
beh
avio
ral h
ealt
h.
o3
.b.i
Evid
ence
bas
ed s
trat
egie
s fo
r d
isea
se m
anag
emen
t in
hig
h r
isk/
affe
cted
p
op
ula
tio
ns
(ad
ult
on
ly).
o3
.d.ii
Exp
ansi
on
of
asth
ma
ho
me
-bas
ed
se
lf-m
anag
emen
t p
rogr
am.
oD
om
ain
4: (
Go
al: T
o jo
intl
y ad
dre
ss c
hro
nic
dis
ease
ris
k re
du
ctio
n a
nd
ast
hm
a ad
mis
sio
ns
du
e to
sec
on
d h
and
sm
oke
).
o4
.b.i.
Pro
mo
te t
ob
acco
use
ces
sati
on
, esp
ecia
lly a
mo
ng
low
SES
po
pu
lati
on
s an
d
tho
se w
ith
po
or
men
tal h
ealt
h.
13
*No
te: T
his
is H
PI’s
init
ialp
roje
ct li
st a
nd
is s
ub
ject
to
ch
an
ge
as f
urt
he
r an
alys
is a
nd
dis
cuss
ion
s p
rogr
ess
du
rin
g th
e p
lan
nin
g p
roce
ss.
HP
I PR
OJE
CT
DES
IGN
GR
AN
T A
PP
LIC
ATI
ON
: C
OM
MU
NIT
Y N
EED
S A
SSES
SMEN
T; V
END
OR
S; B
UD
GET
oH
PI a
pp
lies
for
a D
SRIP
Pla
nn
ing
Gra
nt
oH
PI d
ecid
ed t
o h
ire
a ve
nd
or
to a
ssis
t w
ith
th
e co
mp
reh
ensi
ve c
om
mu
nit
y as
sess
men
t to
en
sure
an
un
bia
sed
ap
pra
isal
of
com
mu
nit
y n
eed
.
oEa
ch p
arti
cip
ant
also
did
its
ow
n in
tern
al e
mp
loye
e a
sses
smen
t to
un
der
stan
d
the
read
ines
s fo
r ch
ange
an
d w
illin
gnes
s to
par
tici
pat
e; a
lso
eac
h a
sses
sed
cu
rren
t an
d f
utu
re w
ork
forc
e n
eed
s in
clu
din
g re
assi
gnm
ent
and
re
-tra
inin
g.
oA
pro
cure
men
t p
roce
ss fo
r a
ven
do
r w
as in
itia
ted
in a
nti
cip
atio
n o
f fu
nd
ing.
oA
des
ign
gra
nt
bu
dge
t an
d a
se
par
ate
cap
ital
bu
dge
t w
ere
dev
elo
ped
an
d
sub
mit
ted
. A
s p
art
of
rep
ort
ing,
th
e sm
all s
afet
y n
et h
osp
ital
no
ted
th
at it
w
ou
ld b
e se
eki
ng
cap
ital
fu
nd
ing
for
clo
sure
as
a h
osp
ital
an
d u
pd
atin
g to
a
med
ical
vill
age.
14
DSR
IP P
RO
JEC
T D
ESIG
N G
RA
NT
AW
AR
DED
!
Let
the
Pro
ject
Pla
nn
ing
Beg
in…
15
DSR
IP P
LAN
NIN
G A
CTI
VIT
IES
oEx
ten
sive
Co
mm
un
ity
Ass
essm
ent
un
der
take
n
oH
PI a
nd
ven
do
r re
view
all
dat
a so
urc
es a
vaila
ble
reg
ard
ing
the
hea
lth
dyn
amic
s o
f th
e re
gio
n.
oH
PI a
lso
co
nd
uct
s n
um
ero
us
com
mu
nit
y m
eeti
ngs
an
d s
mal
ler
nei
ghb
orh
oo
d fo
cus
gro
up
s w
ith
ind
ivid
ual
s an
d v
ario
us
CB
Os.
oH
PI s
ets
up
web
site
to
info
rm c
om
mu
nit
y o
f p
roje
ct p
lan
pro
gres
s an
d s
har
e in
form
atio
n
abo
ut
op
en m
eeti
ngs
an
d o
ther
way
s to
en
gage
an
d p
rovi
de
feed
bac
k to
th
e em
ergi
ng
PP
S
oA
fter
mu
ltip
le m
eeti
ngs
bet
wee
n H
PI P
artn
ers,
its
ven
do
r, t
he
HP
I Pro
ject
Ad
viso
ry
Co
mm
itte
e (P
AC
), a
nd
co
mm
un
ity
stak
eho
lder
s, H
PI l
ead
ersh
ip b
uild
s co
nse
nsu
s o
n
imp
lem
enta
tio
n o
f th
e p
roje
cts
and
dev
elo
pm
ent
of
the
pro
ject
pla
n.
oFi
nan
cial
pla
nn
ing
and
fu
rth
er le
gal p
artn
ersh
ip a
gree
men
ts d
evel
op
ed.
oD
SRIP
Su
pp
ort
Tea
m c
on
sult
ed t
o r
eso
lve
regu
lato
ry is
sues
.
16
HP
I CO
MM
UN
ITY
NEE
DS
ASS
ESSM
ENT:
K
EY F
IND
ING
S
oSm
all C
om
mu
nit
y N
etw
ork
Ho
spit
al s
tru
gglin
g fi
nan
cial
ly d
ue
to e
xces
s in
pat
ien
t ca
pac
ity;
oIn
suff
icie
nt
pri
mar
y ca
re p
hys
icia
ns
du
e re
cru
itm
ent
issu
es;
oSt
rugg
les
in im
ple
men
tin
g P
CM
H;
oP
rob
lem
s im
ple
men
tin
g an
d u
sin
g n
ew E
HR
sys
tem
s an
d
RH
IO c
on
nec
tivi
ty;
17
HP
I CO
MM
UN
ITY
NEE
DS
ASS
ESSM
ENT:
K
EY F
IND
ING
S (C
ON
TIN
UED
)
oLi
mit
ed c
are
coo
rdin
atio
n a
nd
co
mm
un
icat
ion
bet
wee
n t
he
ho
spit
al a
nd
Ski
lled
Nu
rsin
g Fa
cilit
ies;
oLa
ck o
f ca
pac
ity
and
acc
ess
to m
enta
l hea
lth
ser
vice
s;
oPa
tien
t ed
uca
tio
n n
eed
s to
be
add
ress
ed.
Som
e ER
use
is
occ
urr
ing
even
wh
en o
ther
bet
ter
alte
rnat
ives
are
ava
ilab
le
oA
sth
ma
adm
issi
on
s fo
r ch
ildre
n p
rim
arily
in t
wo
zip
co
des
—lo
wer
inco
me/
mix
ed r
esid
enti
al a
nd
ind
ust
ry/h
igh
to
bac
co
use
.
18
HP
I STR
ATE
GIC
PLA
N
oH
osp
ital
A w
ill r
edu
ce 2
0 b
eds.
o
A w
ork
forc
e re
trai
nin
g p
rogr
am, d
evel
op
ed in
co
llab
ora
tio
n w
ith
th
e H
PI P
AC
, will
be
star
ted
fo
r w
ork
ers
wh
o s
taff
ed t
he
bed
s th
at a
re c
losi
ng.
oTh
e co
mm
un
ity
safe
ty n
et h
osp
ital
will
bec
om
e an
ou
tpat
ien
t ca
mp
us.
Th
ey w
ill m
ain
tain
a
stan
d a
lon
e ED
. o
Am
bu
lato
ry s
urg
ery
such
as
end
osc
op
ies
will
rem
ain
at
this
cam
pu
s.
oEx
isti
ng
wo
rker
s w
ill b
e re
trai
ned
to
pla
y n
ew r
ole
s.o
On
e FQ
HC
will
mo
ve in
to t
he
com
mu
nit
y sa
fety
net
ho
spit
al s
ite,
ad
din
g an
urg
ent
care
se
rvic
e an
d c
o-l
oca
tin
g w
ith
th
e b
ehav
iora
l hea
lth
(m
enta
l hea
lth
an
d a
dd
icti
on
ser
vice
s)
clin
ic a
nd
th
e d
enta
l clin
ic a
t th
at s
ite.
o
The
new
clin
ic w
ill f
ully
inte
grat
e p
rim
ary
care
an
d b
ehav
iora
l hea
lth
an
d w
ill m
eet
new
si
ght
stan
dar
ds
asso
ciat
ed w
ith
Ad
van
ced
Pri
mar
y C
are
(AP
C)
mo
del
oTh
e n
ew la
rger
sit
e w
ill a
llow
fo
r m
ore
pri
mar
y ca
re p
ract
itio
ner
s, r
ota
tin
g sp
ecia
lists
an
d
EHR
imp
lem
enta
tio
n. T
his
will
allo
w t
he
FQH
C t
o a
dva
nce
into
a P
CM
H.
This
sit
e w
ill a
lso
lin
k w
ith
th
e ru
ral h
ealt
h c
linic
s fo
r co
vera
ge n
eed
s.
19
oSu
pp
ort
ive
ho
usi
ng
and
co
mm
un
ity
foo
d p
roje
cts
will
hav
e o
ffic
es a
t th
e ab
ove
sit
e fo
r re
ady
acce
ss t
o t
hes
e se
rvic
es.
oSu
pp
ort
ive
ho
usi
ng
will
liai
son
wit
h b
ehav
iora
l hea
lth
to
ad
dre
ss
ho
mel
ess
sub
stan
ce a
bu
se p
atie
nts
.
oA
co
mm
un
ity
farm
er’s
mar
ket,
fo
od
ban
k an
d n
utr
itio
nal
ser
vice
s ar
e p
lan
ned
wit
h t
he
com
mu
nit
y fo
od
pro
ject
.
oTh
e H
ealt
h H
om
es w
ill p
rovi
de
shar
ed s
ervi
ces
in t
he
new
cam
pu
s to
al
low
hig
h r
isk
Med
icai
d m
emb
ers
read
y ac
cess
to
car
e m
anag
emen
t se
rvic
es o
uts
ide
of
tho
se p
rovi
ded
by
the
PC
MH
.
oTh
e H
ealt
h H
om
es w
ill c
on
trac
t w
ith
CB
Os
that
are
cu
ltu
rally
co
mp
eten
t to
per
form
pat
ien
t o
utr
each
, in
clu
din
g h
om
e vi
sits
, in
n
eigh
bo
rho
od
s w
ith
hig
h r
ates
of
avo
idab
le E
R u
se t
o r
aise
aw
aren
ess
o
f al
tern
ativ
e ca
re o
pti
on
s.
HP
I STR
ATE
GIC
PLA
N
20
HP
I STR
ATE
GIC
PLA
N
oTh
e co
mm
un
ity
ho
me
care
ser
vice
pro
vid
er (
HC
SP)
will
dev
elo
p a
n
off
ice
at t
he
Ho
spit
al A
an
d e
stab
lish
a t
ran
siti
on
al c
are
pro
gram
fo
r th
e co
mm
un
ity
and
th
e SN
F in
th
e ar
ea.
The
co
mm
un
ity
HC
SP f
orm
ally
jo
ins
the
emer
gin
g P
PS
as a
mem
ber
; th
ey m
eet
safe
ty n
et c
rite
ria.
oTh
e SN
Fs w
ill w
ork
wit
h t
he
no
w f
ree
sta
nd
ing
ED t
o e
stab
lish
pro
toco
ls
and
an
on
cal
l ser
vice
to
ad
dre
ss a
cute
nee
ds
of
SNF
pat
ien
ts, a
void
ing
ho
spit
aliz
atio
ns.
oTh
is s
yste
m w
ill in
tegr
ate
usi
ng
agre
ed
on
pro
toco
ls a
nd
est
ablis
h
con
nec
tivi
ty w
ith
EH
Rs
and
th
e in
pla
ce h
eal
th in
form
atio
n e
xch
ange
.
oTh
e C
ou
nty
Pu
blic
Hea
lth
wit
h t
he
com
mu
nit
y V
NS
un
der
take
ho
me
asse
ssm
ents
an
d t
ob
acco
ces
sati
on
act
ivit
y in
th
e ta
rget
ed z
ip c
od
es.
21
oH
PI d
evel
op
s th
eir
DSR
IP P
roje
ct P
lan
ap
plic
atio
n in
corp
ora
tin
g th
e se
ven
pro
ject
s id
enti
fied
to
be
mo
st r
elev
ant
to t
he
cou
nti
es t
hey
se
rve.
oFo
r ea
ch o
f th
eir
DSR
IP p
roje
cts,
HP
I dev
elo
ps
a p
lan
nin
g an
d
imp
lem
enta
tio
n a
ctio
n p
lan
.
Exa
mp
le G
an
tt C
ha
rt o
n n
ext
slid
e.
HP
I DSR
IP P
RO
JEC
T P
LAN
AP
PLI
CA
TIO
N
22
3.a
.i I
nte
grat
ion
of
be
hav
iora
l he
alth
into
pri
mar
y ca
reY
ear
1(9
Mo
nth
s)Y
ear
2(9
Mo
nth
s)Y
ear
3
Task
sJu
ly-S
ep
tO
ct-D
ec
Jan
-Mar
chA
pr-
Jun
July
-Se
pt
Oct
-De
cJa
n2
01
6
Ass
essm
ent
BH
svc
s. in
co
mm
un
ity
and
inte
rnal
ly
Ass
ess
read
ines
s o
f FQ
HC
an
d p
ract
ice
site
s fo
r B
H
inte
grat
ion
Dev
elo
p p
lan
nin
g p
artn
ersh
ips
incl
ud
ing
org
aniz
atio
nal
str
uct
ure
, agr
eem
ents
an
d c
on
trac
ts
Ass
ess
IT n
eed
s fo
r sh
ared
ele
ctro
nic
hea
lth
rec
ord
s
Pla
n a
nd
ad
dre
ss c
on
vers
ion
of
clin
ic s
pac
e in
SN
H -
Med
ical
Vill
age
Ad
dre
ss s
tate
req
uir
emen
ts f
or
clin
ic c
on
vers
ion
Co
nve
rt c
linic
sit
e
Imp
lem
enta
tio
n o
f H
IT
Trai
nin
g o
f fo
rmer
ho
spit
al s
taff
to
new
ro
les
in c
linic
Co
mb
ined
FQ
HC
wit
h B
H s
ervi
ces
op
en
Mo
nit
or
met
rics
re:
use
of
serv
ices
an
d a
void
able
h
osp
ital
izat
ion
s
HP
I DSR
IP P
RO
JEC
T G
AN
TT
CH
AR
T (P
RO
JEC
T 3
.A.I
)
23
HP
I DSR
IP P
RO
JEC
T P
LAN
: A
PP
LIC
ATI
ON
V
ALU
ATI
ON
oH
PI’s
go
al is
to
ob
tain
at
leas
t a
90
% s
core
on
th
eir
DSR
IP P
roje
ct
Pla
n a
pp
licat
ion
H
PI h
as c
on
du
cted
a t
ho
rou
gh c
om
mu
nit
y as
sess
men
t an
d h
as
cho
sen
pro
ject
bas
ed o
n t
he
nee
ds
of
its
com
mu
nit
y
H
PI h
op
es t
o r
ecei
ve e
xtra
po
ints
fo
r th
eir
effo
rt in
en
gagi
ng
and
colla
bo
rati
ng
wit
h t
hei
r co
mm
un
ity
org
aniz
atio
ns
to d
evel
op
its
pro
ject
pla
n
oW
ith
hel
p f
rom
th
e st
ate,
HP
I has
det
erm
ined
th
e M
edic
aid
p
op
ula
tio
n a
ttri
bu
ted
to
its
PP
S is
10
0,0
00
live
s.
24
HP
I DSR
IP D
RA
FT P
RO
JEC
T P
LAN
:
AP
PLI
CA
TIO
N V
ALU
ATI
ON
Pro
ject
Val
ue
Pro
ject
In
de
x Sc
ore
Val
uat
ion
B
en
chm
ark
(7 P
roje
cts)
Pro
ject
P
MP
M#
Me
dic
aid
M
em
ber
s
Pro
ject
P
lan
A
pp
licat
ion
Sc
ore
# D
SRIP
M
on
ths
Max
. Pro
ject
Val
ue
2.a
.i C
reat
e In
tegr
ated
Del
iver
y Sy
stem
s th
at a
re f
ocu
sed
on
Evi
den
ce B
ased
M
edic
ine
/ P
op
ula
tio
n H
ealt
h
Man
agem
ent
56
0.9
3$
6.8
0$
6.3
21
00
,00
00
.96
0$
3
4,1
28
,000
.00
2.a
.iv C
reat
e a
med
ical
vill
age
usi
ng
exis
tin
g h
osp
ital
infr
astr
uct
ure
54
0.9
0$
6.8
0
$6
.12
10
0,0
00
0.9
60
$
33
,04
8,0
00.0
0
2.b
.v C
are
tran
siti
on
s in
terv
enti
on
fo
r sk
illed
nu
rsin
g fa
cilit
y re
sid
ents
41
0.6
8$
6.8
0
$4
.62
10
0,0
00
0.9
60
$
24
,94
8,0
00.0
0
3.a
.i In
tegr
atio
n o
f p
rim
ary
care
ser
vice
s an
d b
ehav
iora
l hea
lth
39
0.6
5$
6.8
0
$4
.42
10
0,0
00
0.9
60
$
23
,86
8,0
00.0
0
3.b
.i Ev
iden
ce b
ased
str
ateg
ies
for
dis
ease
m
anag
emen
t in
hig
h r
isk/
affe
cted
p
op
ula
tio
ns
(ad
ult
on
ly)
(car
dio
vasc
ula
r)3
00
.50
$6
.80
$
3.4
01
00
,00
00
.96
0$
1
8,3
60
,000
.00
3.d
.ii E
xpan
sio
n o
f as
thm
a h
om
e-b
ased
se
lf-m
anag
emen
t p
rogr
am3
10
.52
$6
.80
$
3.5
41
00
,00
00
.96
0$
1
9,1
16
,000
.00
4.b
.i. P
rom
ote
to
bac
co u
se c
essa
tio
n,
esp
ecia
lly a
mo
ng
low
SES
po
pu
lati
on
s an
d
tho
se w
ith
po
or
men
tal h
ealt
h2
30
.38
$6
.80
$
2.5
81
00
,00
00
.96
0$
1
3,9
32
,000
.00
Max
imu
mA
pp
licat
ion
V
alu
e$
16
7,4
00
,00
0.0
0
25
HP
I has
est
ablis
hed
a f
un
d d
istr
ibu
tio
n w
hen
per
form
ance
pay
men
ts
are
rece
ived
:
For
Safe
ty-N
et E
ligib
le P
rovi
de
rs (9
5%
of
Max
imu
m A
pp
licat
ion
Val
uat
ion
)
7
0%
will
be
ass
ign
ed
to
th
e co
st o
f th
e p
roje
ct (
incl
ud
ing
lost
rev
enu
es)
b
ased
on
sh
ifti
ng
reso
urc
es, s
taff
an
d p
rogr
am li
ne
s. (
$1
11
.3 m
illio
n).
1
0%
will
be
ass
ign
ed
to
pro
gram
ad
min
istr
atio
n in
clu
din
g st
aff,
con
sult
ants
. ($
15
.9 m
illio
n).
2
0%
will
be
ass
ign
ed
fo
r b
on
us
pay
men
ts t
o p
artn
ers
for
ach
ieve
me
nt
bey
on
d t
he
exp
ect
ed m
ilest
on
es. (
$3
1.8
mill
ion
).
HP
I FU
ND
ING
DIS
TRIB
UTI
ON
: FL
OW
OF
FUN
DS
AG
REE
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3,2
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0
Comment
NumberSection: Theme: Comment: Who?
Modify
I?
Modify
J?
Modify
Toolkit?Comment:
1 I Attribution
Ensure attribution is transparent; clarify how duals
will be handled; provide clarification of initial
attribution and true up process; avoid attribution
issues as in HH; address LTC provider in attribution;
clarify attribution for providers in more than one PPS;
solicit active participation and input from PPS for final
attribution
HANYS (Summary listed here;
multipage specifics)x
2 I AttributionUninsured need to be attributed to PPS, not just
Medicaid; there are data sourcesMedicaid Matters x
I AttributionUninsured need to be attributed to PPS, not just
Medicaid; there are data sourcesJ. Wessler x
3 I AttributionIndividual preferences and differences are not
considered in PPS designation;New York Immigration Coalition x
4 I Attribution Does not include the uninsured New York Immigration Coalition x
5 I AttributionUninsured need to be attributed to PPS, not just
Medicaid; there are data sources
Commission on the Public's
Health Systemx
6 I Attributionadd school based health utilization into the
attribution algorithmMontefiore x
7 I Attribution
Concerns that attribution methodology will allow
cherry picking; affect small primary care practices not
in PPS
NYC Dept. of Health Mental
Hygienex
8 I AttributionShould be adjusted for each measure to align with
population affected by the measureWestchester Medical Center x
9 I AttributionSection 2.c. PPS should have time to review the final
attribution after the MCO inputWestchester Medical Center x
10 I Attribution Should include those in LTC- section II.c.Continuing Care Leadership
Coalitionx
11 I Attribution
Wants hospital outclinics that meet safety net
threshold be permitted to join PPS even when
hospital does not meet goal; concerns with Plans
reviewing attribution -- wants state to have plan to
validate the MCOs' decisions
GNHA x
12 I AttributionWants PCMHs to receive preferential service priority
when attributing patients--should be first priorityCHCANYS x
13 I Attribution
Role of MCO in reviewing attribution needs to be
further defined and specific criteria listed that they
will use;
CHCANYS x
14 I AttributionWants those with disabilities /living in supervised
residences be attributed to the PPSAHRC Nassau x
15 I Attribution
Wants clearer definition of care management to
insure implications of the methodology are
transparent to providers and clients; not clear Nurse
Family Partnership Clients are in the care
management attribution
Public Health Solutions x
16 I Attribution
Exclusion of members who have plurality of services
from non-PPS provider should be revisited; should be
reviewed with PPS to see if should be included; work
with the involved non-participating providers to see if
can bring into PPS;
NYAPRS x
17 I Care coordination Need clarity on the definiton of case management NYAPRS x
18 ICommunity Needs
Assessment
Should include social determinants of Health; should
include assessment of disabilities; should be a
requirement infulfillment of Olmstead
Medicaid Matters X
Community needs assessment needs
to consider institutionalized; C.J.
persons
19 ICommunity Needs
Assessment
Should include individuals in institutions and the
community; include the disabled; should be required
to include providers who serve the disable;
NYAPRS X
Community needs assessment needs
to consider institutionalized; C.J.
persons
20 ICommunity-based
Groups
Clear delineation of process for including CBO is
neededNew York Immigration Coalition
Already included in PPSs and part of
community needs assessment; clarify
in FAQs
21 ICompliance with Civil
Rights Law
PPS should be assessed for their compliance with non-
discrimination laws.
Center for Independence of the
Disabled, NYx Add specific language to I
On all attribution items we will take
comments into consideration as part
of a revise we are doing to attribution
to break out attribution rules by
population (BH, DD, LTC, Other).
22 I Confidentiality Issues
Confidentiality is the cornerstone of reproductive
health care services. Concerns re: sharing of health
information re: this topic, most particularly for
adolescents; asks to have added on page 12, # 11 :
"all privacy protections contained in HIPAA and New
York Law"
Family Planning Advocates of NYS Xadd "and New York Law"; Federal law
has less protections for adolescents
23 I Consumer concernsNothing is stated about the welfare of individual
patientsNYS Public Employees Federation x
Add more emphasis on consumer
engagement
24 IConsumer
engagement
State should implement a strategic plan to educate
and involve Medicaid members; include
multilanguage materials
Schuyler Center x
1) Will use some administation funds
to do consumer education
campaign/RFP process; 2) PPS will be
required to provide multilanguage
materials based upon community
25 IConsumer
engagement
Consumer feedback should be solicited in mid-point
assessmentSchuyler Center CAHPS will provide this feedback.
26 IConsumer
engagement
Need the Medicaid director and staff to tour the state
and sit down with Medicaid members to solicit input
in the same way as done with MRT
Medicaid Matters
After final applications are received,
will do Medicaid member focus
groups in at least 5 locations
IConsumer
engagement
Community residents and organizations could/should
be involved in PPS and planning; will not work unless
ongoing involvement of consumers and workers
J. Wessler x
Community involvement will occur
with community needs assessment,
consumer involvement with Quality
Council, and consumer invovlement
with Learning Collaborative. PAC will
include labor/workers.
27 I Data Wants more information on the portal CHCANYS x Will be provided in future Webinars
28 I DOH Staffing
Need more state staff for this project; state should
publicly offer a strategic plan to transform and
integreate state systems in alignment with MRT
Medicaid Matters Staffing in progress.
29 I DOH Staffing
Need more state staff for this project; state should
publicly offer a strategic plan to transform and
integreate state systems in alignment with MRT
Commission on the Public's
Health SystemStaffing in progress.
I DOH Staffing
The State Health Department has been losing
staff, yet it has a major role in planning, data
development, technical assistance, monitoring,
and evaluation of DSRIP/PPS
J. Wessler Staffing in progress.
30 I DSRIP FundingLanguage appears to favor voluntary hospitals at the
expense of the resources for public facilities --50 -50,New York Immigration Coalition
Will provide clarity in webinars;
misinterpretation
31 I DSRIP FundingPublic hospitals must receive their fair share of
funding
Commission on the Public's
Health System
Will provide clarity in webinars;
misinterpretation
32 I DSRIP FundingPublic hospitals must receive their fair share of
fundingNYS Public Employees Federation
Will provide clarity in webinars;
misinterpretation
I DSRIP Funding
Issues with public hospitals and funding; lack of
clarity that they will have access to the full share of
the public hospital funding
J. WesslerWill provide clarity in webinars;
misinterpretation
33 I DSRIP Goals
Concerned that 25% reduction in unnecessary
hospital admissions is equated to reducing actual
capacity by 25%; unnecessary is not defined
NYS Nurses Association
Understand the concern; no equation
for specific bed reduction; can
provide clarity in webinars
34 IDSRIP Reivew
Checklist
Want the following added: -Marketing component for
outreach and motivating beneficiaries to take
advantage of new integrated health care system; -the
plan demonstrates that the current assets and
systems in place of collaborating providers are
beneficial in achieving successful outcomes; -the plan
describes current database systems providers are
using to collect and analyze data, to maximize results;
-the plan supports opportunities to partner with
educational institutions to research results and
performance improvement options
NYC Dept. of Health Mental
Hygiene
Noted; not clear changes are
necessary
35 I FQHC Should be part of the processCommission on the Public's
Health System
Are already part of process; webinar
can clarify members of PPS
36 I GovernanceShould include representatives of community based
providers and consumersSchuyler Center
Add one Medicaid member to the
PAC
37 I Governance
the evolution of the PPS into a highly effective
integrated delivery system should be resisted;
suggests a mandate which goes beyond both federal
and state statute
NYS Public Employees Federation Comment noted
38 I GovernanceWants to ensure community based safety net
providers are included in governanceCHCANYS
No change required; will clarify in
webinar
39 IHigh performance
Fund
wants clarity on how this will used/awarded/do all
metrics have to be top performing to achieve this/etcGNHA
No change required; will clarify in
webinar
40 IHigh performance
Fund
Wants a condition to be incorporated that some of
the money to be used to facilitate front line staff's
ability to participate in Learning Collaboratives
Next WaveNoted; not clear changes are
necessary
41 I IAAF
Safety net definitoin is too broad and results in
supporting hospitals with minimum Medicaid service;
make decision making process open to the public;
New York Immigration CoalitionNo changes will be considered to
safety net definition.
42 I IAAFNo funding in IAAF to expand community based
ambulatory servicesNew York Immigration Coalition No changes in eligiblity at this time
43 I IAAF$ should be immediately available and go to health
facilities in high need areas
Commission on the Public's
Health SystemNo changes in eligiblity at this time
44 I IAAF
Issues with eligibility for IAAF; feels too broad and
may support hospitals that have consistently failed to
meet state quality standards; should include public
disclosure of assets; public review and comment on
IAAF applications with state-wide stateholder panel
reviewing final recommendations; committement of
IAAF applicants to engage in a full internal audit of
care delivery, etc; independent analysis of any and all
psychiatric treatment facilities based on quality
control and ethical treatment; IAAF should be held to
higher degree of scrutiny in designing their PPS with
full DOH participation at all area meetings as PPS
emerges; PPS design process for each IAAF should be
fully public with mandatory inclusion of community
members
NYAPRS
Noted; No changes will be considered
to safety net definition; process will
be consistent for all applying PPSs.
45 I IAAF
The requirement that the public hospitals develop
special projects in order to access funding for this
special pool is an unfair burden that is not placed on
the non-public hospitals; funding should also be
available to out-patient settings
District Council 37 AFSCME AFL-
CIO
Noted; No changes will be considered
to eligibility
46 I IAAFFeels IAAF eligibility requirements will exclude most
safety net providersNYS Nurses Association
Noted; No changes will be considered
to eligibility
47 IIndependent
Assessor
Should not be from NY and should not be chosen
from a list of state contracted consultants;
community based advocates should participate in the
development of criteria for the IA and IE and must be
involved as they complete their task.
Commission on the Public's
Health SystemNoted; no change
48 IIndependent
Assessor
definition of IA should be straightforward -- no
existing ties to any applicants nor any existing
commerical ties for similar work with the state.
NYS Public Employees Federation Noted; no change
49 I Labor relations
Labor/management collaboration should be
recognized in all domains of I and J, tied to
scoring(project index score) and award amount
allocated
NYS Public Employees FederationPAC developed to ensure labor
involvement
50 I Labor relations
Wants amendment to show that union
representatives must participate in planning,
development and implementation; that nothing shall
contravene collective bargaining agreements; if not
involved, project should be devalued; labor should be
included in goverance; PPS that is providing IGT must
be the lead
NYS United Teachers; United
Univeristy Professions
PAC developed to ensure labor
involvement
51 ILearning
Collaboratives
Should be made public and involve community
stakeholders
Commission on the Public's
Health Systemx Add language to I
52 ILearning
CollaborativesGNYHA wants to be included in this process GNHA x Add language to I
53 I LGUWants local government to consult with state during
review of DSRIP plans
NYC Dept. of Health Mental
HygieneNoted
54 I MCO Wants clarify on alignment of MCOs with DSRIP CHCANYS Noted; can be webinar topic
55 I MCO
Require MCOs that contract with DSRIP PPS to
reimburse home health services on an episodic basis
as has been the state's process
VNSNY/MJHS State reimbursement issue; noted
56 I Payment Reform
Should begin in year 1; should be accelerated and
should prioritize primary care-- need road map for
amending Medicaid Managed care contract terms--
form of payment and adequacy must be addressed
Primary Care Development
CorporationNoted
57 I Payments
Ensure that payment strategy of incentives gets to
the providers who are responsible for the activity and
not to the largest entities
CHCANYS X
Modify I to include reference to state
issuing guidance on models
distribution of downstream dollars.
58 I Planning GrantsShould be commensurate with the size of the
organizationWestchester Medical Center
Reviewed; would disadvantage rural
networks; no change anticipated
59 I PPS
There is lack of clarity in what defines a hospital's
relationship to the community in order to qualify as a
DSRIP provider; need community involvement in
planning
Commission on the Public's
Health SystemNoted; can address in webinar
60 I PPSRequire a comprehensive primary care plan of each
DSRIP PPS
Primary Care Development
CorporationX X Add to Domain 2 as requirment (IDS)
61 I PPSClarify that appropriate primary care practices and
networks can serve as lead coalition provider
Primary Care Development
CorporationNo language limiting them;
62 I PPS
Solo and independent group PCPs are not being
considered by the PPSs; Need a comprehensive PCP
plan for each PPS
NYC Dept. of Health Mental
Hygiene
Noted; will address during planning;
Support teams will ensure addressed
63 I PPS
Concerns some Brooklyn hospitals will be at unfair
disadvantage because of financial status, but do care
for a large number of Medicaid,etc.
NYC Dept. of Health Mental
HygieneNoted; IAAF will assist
64 I PPSData management will be burdensome; plan to
incorporate a third party to help
NYC Dept. of Health Mental
Hygiene
Noted; Support teams can help
address this issue
65 I PPS
Section 2.b. re: waivers-- State and CMS should
confer the same set of waivers approved for other
value based purchasing arrangements
Westchester Medical Center Noted
66 I PPS
State should describe and develop plans to
communicate with beneficiaries regarding their
participation in DSRIP
Westchester Medical Center
Will use some administation funds to
do consumer education
campaign/RFP process
67 I PPS
Should include long term care and be scored higher
based on this; LTC should include specialty care such
as HIV, etc
Continuing Care Leadership
Coalition
Noted; will consider for clarification in
project valuation
68 I PPS Should include a minimum number of persons in LTCContinuing Care Leadership
CoalitionNoted
69 I PPSWants responsibilties of lead to be more clearly
definedGNHA x
70 I PPSPCP patients should be attributed to more than one
PPS so as not to disadvantage PCPsCHCANYS
Understand issue of PCPs admitting
to more than one hospital, but not
feasible to do this with attribution,
metrics
71 I PPSWants to ensure the review process for PPS will look
for missing community/social service organizationsNext Wave x x Review of PPS will include this issue
72 I PPSAHECs should be included in the PPS for the role they
play in supporting health professional education.AHEC x
Added to list of Community Partners
in Community Needs Assessment
already; can note in IDS
73 I PPS
Regions -- concerns re: geographic regions of the PPS
are overly broad to facilitate local engagement--
should assess relative to more local regions -Regional
Health Improvement Collaboratives
Next WaveNoted; PPS will essentially drive the
geographic/service area they serve.
74 I Primary Care Services
There is no designated funding to expand primary
care services. (LKH Note --another provider put this
under the IAAF--not sure if this is where it is meant to
be by this org.)
Commission on the Public's
Health System
No change required; addressed
through DSRIP projects as well as
other funding streams in waiver
I Primary Care Services
There is no designated funding to expand community
based ambulatory care services; issue with medically
underserved communities lacking priamry care
resources.
J. Wessler
No change required; addressed
through DSRIP projects as well as
other funding streams in waiver
75 I
Primary Care
Technical and
Operational
Assistance
Restore this moneyPrimary Care Development
CorporationNoted; Not able to do
76 I
Primary Care
Technical and
Operational
Assistance
Restore this money -- concerns with reach PCMH
Level 3/2014 standards and RHIO connectivity if
money is not funded
NYC Dept. of Health Mental
HygieneNoted; Not able to do
77 I Project AchievementSection 7. wants quarterly reporting and payment to
smooth cash flowWestchester Medical Center Not consistent with STCs
78 I Project Plan
Streamline the reporting process to reduce burden on
the PPS; provide clarification of service areas; remove
duplicative requirements related to documenting
safety net status; better characterize regional
planning as community planning; eliminate
unnecessary and inconsisten budgeting requirements
since DSRIP is performance based; engage with
HANYS and others on governance structure; provide
multiple template governance agreements as
voluntary guidelines to the PPSs.
HANYS (Summary listed here;
multipage specifics)x
Several comments from this group
will be picked up in I changes.
79 I Project Plan
Duplication of effort for the PPS to have to provide
more support for safety net status when state has
done it already; feels detailed budget is not necessary
since payments are not based upon the budget
GNHA x
80 I Project Plan Review
Ensure ongoing dialogue and review prior to mid-
point assessment; permit PPS appeal of independent
assessor reviews; provide technical assistance to
under performing PPSs.
HANYS (Summary listed here;
multipage specifics)x
State will engage Medicaid members
in focus groups and consult with PPS
and state associations as part of mid
point assessment and ongoing
dialogue/are we going to address
question of appeal
81 I Project Plan Review
Project plans should reflect networks relative to other
state health transitions including Managed care; HHs,
IPAs; regional centers of excellence for behavioral
health; project include assessment of social health
determinants and inclusion of providers not in
Medicaid but who provide socially necessary services;
should include how these providers will have financial
needs met; 5 year projection of necessary changes ot
the PPS to ensure value-based projects are also
rehabiliation and recovery oriented specifically for
persons with disabilities;
NYAPRS x xWill work recovery/community
support terminology into projects
82 I Project Review
Section 6.b - wants PPS to have the opportunity to
review comments of IA and be able to provide
corrective changes
Westchester Medical Center Noted; will discuss in webinar
83 I Project Review Wants details on termination process Westchester Medical Center Noted; will discuss in webinar
84 I Project Valuation
Ensure a transparent process with full details
provided to each PPS; improve calibration for
discounting PPS project selections; disclose scoring
details and ability to appeal; consider front-loading
annual project value in early years to reflect need for
upfront funding; all partial credit/not just pass/fail.
HANYS (Summary listed here;
multipage specifics)x Transparency language?
85 I Quality Council Should include consumers representation Schuyler Center x Will add
86 I Quality Council Want LGU representative on Quality CouncilNYC Dept. of Health Mental
Hygienex Will add
87 I Quality Council Want PPS representation Westchester Medical CenterDetermined this would be a conflict
of interest
88 IReporting
Requirements
streamline and simplify reporting to avoid
duplication; use Core Measure Vendors as a possible
model; expand the breadth of learning collaboratives;
develop a method to distribute performance measure
payments more than once a year; provide
clarification of interim and summative evaluation
standards; reconcile real time reporting to the annual
performance data; accelerate development of the
portal
HANYS (Summary listed here;
multipage specifics)x
Add specificity on flowing payments
between the years. Tie the project
valuation amounts to the annual
DSRIP fund targets from STCs.
89 I Safety Net Definition
Should be limited to organizations that have
substantial responsibility for
uninsured/Medicaid/Duals
NYS Public Employees FederationSafety net definition in STCs; no
changes will be requested.
90 I Safety Net Definition Too broad -- needs to changeCommission on the Public's
Health System
Safety net definition in STCs; no
changes will be requested.
ISafety Net
Definition/IAAF
Safety net definition is too broad and results in
supporting hospitals that do not need the funds; This
is make decision making process open to the public;
This is particularly a problem since decisions about
this funding is solely in the hands of the State Health
Department (Governor) during an election year. In
other states with a DSRIP programs limit funding to a
true public and voluntary providers. We know that
hospitals maintain different sets of financial
information, so that even the financial status of a
hospital can be reported in different ways. This is
undoubtedly true within large hospital systems,
where money can be moved around. Redefine safety
net. Make decision making process for distribution of
funds open to the public for IAAF.
J. WesslerSafety net definition in STCs; no
changes will be requested.
91 I Safety Net Definition
wants adjustments for those providers who see far
more of Medicaid, uninsured, duals than allowed for
currently
NYC Dept. of Health Mental
Hygiene
Safety net definition in STCs; no
changes will be requested.
92 I Safety Net DefinitionShould be changed to 50% Medicaid, uninsured and
dual eligible
District Council 37 AFSCME AFL-
CIO
Safety net definition in STCs; no
changes will be requested.
93 I SHIP
Ensure integration of DSRIP and SHIP/ a clear chain of
authority for managing these two interrelated
initiatives should be clearly stated
Primary Care Development
Corporation
State level issue; will address in
webinar
94 IState level review
processWho would qualify as a public stakeholder? GNHA x
95 I State Performance How are managed care payments handled? GNHACan clarify in webinar after managed
care plan completed
96 I Valuation
Fairest approach is to create a formula that takes into
consideration each facilities' relative proportions of
Medicaid/uninsured/dual eligible; actual funding
should not be solely on PMPM but further adjusted
for payer mix to ensure institutions with greater need
get more money;
NYS Nurses Association
97 I Valuation
PMPM of $15 is arbitrary; all project values appear to
be arbitrary; free of evidence grounded in clincial or
organizational experience
NYS Public Employees Federation
98 I Valuation
Does not agree with different value scores for
creating a medical village in hospitals vs. nursing
homes
Eva Eng
99 I Valuation
State should raise valuation benchmarks in line with
the $15 pmpm. Should not be discounted based upon
projects
Westchester Medical Center
100 I Valuation Wants pass/fail process with pass being give 100% Westchester Medical Center
101 I ValuationWants partial credit for improving metric; not
pass/failWestchester Medical Center
102 I Valuation SNF projects are valued less than hospitalContinuing Care Leadership
Coalition
103 I Valuation
Wants valuation to consider the risk of the
population; also wants to use average selected
project score
GNHA
Valuation Comments will be taken
into account as part of overall
changes to valuation being discussed
with CMS.
104 I ValuationWants application score criteria be more clearly
definedCHCANYS
105 I/JCommunity-based
Groups
State should create a designated "Office of Technical
Assistance" within the DOH with special
representatives for community groups to enhance
opportunities for non-traditional providers
Medicaid Matters
Learning Collaboratives and Support
Teams are available to provide this
assistance
106 I/JCommunity-based
Groups
Need an Office of Technical Assistance for community
groupsHealth People
Learning Collaboratives and Support
Teams are available to provide this
assistance
107 I/J DisparitiesProjects focused on disparities are not seen as high
priority as they are scored lowed in the metrics.
Commission on the Public's
Health Systemx
Noted; addressing disparities is
included in all projects; will review in
Toolkit to ensure clarity on this.
108 I/J Metrics
Provide a reporting waiver for areas affected by
natural disasters; use risk adjusted measures where
possible; appropriately weight the potentially
avoidable services; provide separate behavioral
health measures for the preventables; revise the
clinical improvement metrics for DM (Remove PQI # 3
and replace with PQI # 14)
HANYS (Summary listed here;
multipage specifics)x
Noted re: issue of natural disasters
and will identify a solution; will
review the metric again-note the
concern
109 I/J MetricsWants adjustments of performance measure for socio-
demographic statusNext Wave
Noted; no changes anticipated in
measure evaluation
110 I/J MetricsState should provide potentially avoidable hospital
measures for most SNF ; encourage SNF partnership
Continuing Care Leadership
Coalitionx x Ensure SNF partnership in PPS
111 I/JWorkforce strategy;
Projects
Include Community Health Workers and use of Peers
in the PPS workforce strategy and milestonesSchuyler Center x x
Add CHW and assistance with
outreach and health navigation to IDS
112 J Care coordination
Issues raised about role of care management such as
in HH vs. that in MMCP; Better define care
management; clarify if voluntary; delineate
safeguards for consumer confidentiality; clarify if
consumers can choose a care manager; clarify service
suite allowed; eligibility; appeals; description of staff
qualifications for care management and structure for
each model/definition of care; set case load limit
policies; define process for client feedback; define
how consumers can file a grievance; explain the
interrelationship between disease management and
case management and coordination between
relevant providers
Medicaid Matters
Noted; can addres in webinar; some
of this is addressed from Medicaid
Managed Care regulations and Health
Home policy
113 J DataConcerns around standardization of data; wants
reporting through RHIOs
NYC Dept. of Health Mental
HygienePortal will address this issue.
114 J DataConsideration has to be given for data issues from
Hurricane Sandy
NYC Dept. of Health Mental
HygieneNoted
115 J Disparities People with disabilities are not mentioned Elizabeth BerkaAre addressed in community needs
assessment
116 J DisparitiesAddressing disparities not adequately evaluated by
metrics; Metrics do not capture effect of SES
Fingers Lakes Health Systems
Agency
Data will be provided that can be
sorted by disparities for use by PPS;
small cell size and lack of standards
limit use for the state as a whole
117 J Disparities
Inadequate evaluation of disparities; PPS should
identify race, ethnicity, etc of population they serve
so they can comply with all civil rights laws; Domain 4
metrics should better capture all health disparities
not just the few listed.
Center for Independence of the
Disabled, NYx
Data will be provided that can be
sorted by disparities for use by PPS;
small cell size and lack of standards
limit use for P4P or P4R for the state
as a whole
118 J DisparitiesMeasures should track disparities by age,
race/ethnicity/genderSchuyler Center x As above
119 J Disparities
Inadequate evaluation of disparities; PPS should
identify race, ethnicity, etc of population they serve
so they can comply with all civil rights laws; Domain 4
metrics should better capture all health disparities
not just the few listed.
Medicaid Matters
Data will be provided that can be
sorted by disparities for use by PPS;
small cell size and lack of standards
limit use for the state as a whole
Valuation Comments will be taken
into account as part of overall
changes to valuation being discussed
with CMS.
120 J DisparitiesRacial and disability disparities are not measured and
trackedNew York Immigration Coalition x
Data will be provided that can be
sorted by disparities for use by PPS;
small cell size and lack of standards
limit use for the state as a whole
DisparitiesRacial and disability disparities are not measured and
trackedJ. Wessler x
Data will be provided that can be
sorted by disparities for use by PPS;
small cell size and lack of standards
limit use for the state as a whole
J Attribution
Individual preferences and differences are not
considered in PPS designation; unclear how race and
ethnicity, primary language and disability are
considered, if at all
J. Wessler x
121 J HIVSyringe exchange programs were not included in
Project 3.e.i HIV/AIDSNY Academy of Medicine x
122 J Metrics
‘Avoidable ED algorithms’ use will yield
underestimated truly avoided visits. Suggest using
algorithms initially, but follow with rate adjusted for
identifiable impacts
Fingers Lakes Health Systems
Agency
Noted; concerns with standardized
measure over the years of the
project;
123 J MetricsPQI is very limiting as many avoidable admissions are
not measured.
Fingers Lakes Health Systems
Agency
Noted; these are standardized
measures with baselines for
comparison; could look at PPA as
broader.
124 J Metrics
Allow flexibility for exceptions to the project list;
utilize NY Medicaid data to set performance targets;
provide clarification on baseline data updates and
impact on performance targets; avoid use of a
moving target for performance evaluation
HANYS (Summary listed here;
multipage specifics)Will not be adding new projects
125 J MetricsNo metric to measure quality of care for persons with
LEPSchuyler Center
Noted; Data will be provided that can
be sorted by disparities for use by
PPS; small cell size and lack of
standards limit use for the state as a
whole
126 J Metrics
State should measure the physical access challenges
for members and how providers are addressing; need
a metric
Schuyler CenterThis is be done through the NYS
Capital funding
127 J Metrics
Need more flexibile approach to metric selection with
flexibility to propose additional metrics outside of the
proposed list and to select limited subset from
proposed metrics
Montefiore No change planned
128 J Metrics
Clarification needed on establishment of metric
targets; must the state always chose between state
and national or can DOH use discretion? Wants
discretion
GNHA
Additional information on baselines
and targets will be provided in
webinar
129 J Metrics Do some metrics require medical record review? GNHA Yes; no changes required
130 J MetricsMove base year so does not include disruption by
SandyNext Wave Noted; under consideration
131 J MetricsTechnical corrections were submitted internally to
correctLindsay Cogan X Internal technical corrections done
132 J Project Projects should be developed locally and not by state NYS Public Employees Federation Noted
133 J Project
System transformation - nothing inherently valuable
in any of the listed tasks; PCMHs have not improved
care
NYS Public Employees Federation Noted
134 J Project
Domain 3 Top down planning is inefficient; planning
based on sloganeering will be ineffective; and
dissipation of funds will lead to inequity; measure
stewards listed do not have any supporting
documentation or are proprietary;
NYS Public Employees Federation Noted
135 J Project
Domain 4 measures have not apparent basis in any
analysis and only the general basis references to
source; suffers from imprecision in definition,
inattention to demonstration of the relevance of the
measure to improvement in public health , lack of
linkage to any peer reviewed or well accepted
evidence;
NYS Public Employees Federation Noted
136 J Project
Project 2.a.v --more flexibility should be given to SNF
to reduce bed capacity while developing alternate
resource use at a different site
Eva Eng Noted
137 J ProjectDomain 2 should not be capped at four projects;
should be able to do 8Eva Eng Noted
138 J Project
Medical village--"we would like to underscore the
importance of having channels for repurposing
inpatient capacity for other, non-inpatient uses such
as urgent care and want to clarify that this type of
activity will be fully supported
Montefiore xNoted; will clarify in toolkit can
discuss further in webinar
139 J Project
Project 2.a.i -- concerns expressed re: this will
increase in primary care; provide projections of
primary care capacity; concerns re: supporting
electronic HR-- need mechanism for relief if do not
meet due to factors out of control of the PPS; NCQA
2014 Level 3 is too aggressive; NYS Medicaid pays an
incentive on 2011 so PCPs may stay with that to gain
that money;100% RHIO connectivity by year 3 should
be revised if affected by factors out of control of PPS;
NYC Dept. of Health Mental
Hygiene
Noted; in discussion with Office of
Quality and Patient Safety; no
changes in J or toolkit
140 J Project
Project 2.a.iii-- change to patients eligible for but not
enrolled in HH; many people already eligible for HH
but not enrolled
NYC Dept. of Health Mental
Hygiene
Changes intent of project; no changes
anticipated
141 J Project
2.B.ix -- observation programs - if such programs
become more standard, patients may incur charges
from insurance companies that don't cover them
NYC Dept. of Health Mental
HygieneNoted;
142 J Project Domain 2 concerns about timely access to dataNYC Dept. of Health Mental
Hygiene
Noted; portal will enhance access to
state available data
143 J Project
How will PPSs be protected from being
inappropriately penalized for high hospital
readmission rates?
NYC Dept. of Health Mental
HygieneNoted
144 J ProjectDomain 2 - Wants BMI added to this list since all
adults should be screened for theirBMI
NYC Dept. of Health Mental
Hygiene
Noted; recognize the importance of
BMI; not clear fits Domain 2;
collection difficulties
145 J Project
Domain 2- Want rates of incarcertaion and/or arrest
be considered an avoidable event to measure
transformaton
NYC Dept. of Health Mental
HygieneGood idea; data availability is an issue
146 J ProjectDomain 3 wants to use NQF #0028 instead of #0027;
used in MU
NYC Dept. of Health Mental
Hygiene
This was a discussion with CMS;
#0027 was agreed on
147 J Project
Domain 4 - wants percentage of mothers exposed to
intimate partner violence; rates of tobacco use at the
end of pregnancy and three months postpartum
based on results of NYC Preg. Risk Assessment
Monitoring System
NYC Dept. of Health Mental
Hygiene
Noted; will continue alignment with
Prevention Agenda; adding additional
metrics not collected on a state-wide
basis
148 J Project
MOLST should be specifically called out in palliative
care projects; in 3.g.i, more than IHI's "Conversation
Ready" should be allowed
CompassionAndSupport.org x Agreed; will add
149 J ProjectWants definition of eligible providers for RHIO, etc to
allign with meaningful useWestchester Medical Center Already is aligned; can clarify in FAQs
150 J ProjectFor Domain 2, C. connecting systems, does not want
all metrics from A and B to apply; wants a subsetWestchester Medical Center Noted; no change warranted
151 J Project
Domain 3 clinical improvement; wants PPS to be able
to propose specific metrics; their project for prenatal
is one year but the metrics are for two years
Westchester Medical Center Noted; no change warranted
152 J Project Palliative Care issues with using UAS Westchester Medical Center Noted; no change warranted
153 J Project Wants more flexibility in picking Domain 2 projectsContinuing Care Leadership
CoalitionNoted; no change warranted
154 J Project Confusion on the use of project in two ways GNHATerminology from CMS; no change is
planned
155 J Project
For Article 40 hospices to work with behavioral health
clients, there is need for regulatory relief; is this being
considered
Hospice and Palliative Care of St.
Lawrence Valley
Called this provider and advised him
this is possible; will need to provide
the information for review
156 J Project
Wants DOH to expand upon definiton of evidence
based home visiting to include other successful
models in addition to NFP such as HFNY
Public Health Solutions x Noted; will add in toolkit
157 J Project
Want an additional project that exclusively focuses on
increasing access to and use of contraceptive
methods with a focus on long-acting reversible
contraceptives
Public Health Solutions No additional projects will be added
158 J Project
Modifications: 2.a.v--expand to psychiatric facility,
congregate housing unit or other institution that may
be modified to offer community based services and
housing supports; 2.b.iii-ED care triage for at risk
populations--before and after admission to transition
to appropriate community supports;
NYAPRS x
will work language into toolkit --
cannot change 2.a.v without
significant change in intent;
159 J Project
Add: 2.c.iii--expand transportation access for health
and non-health related appointments for at-risk
populations; 3.a.vi -- Outreach and engagement to
behaviorally at risk populations in underserved
communities; 3.e.ii --Behavioral health interventions
for persons with HIV/AIDS
NYAPRS x
will work language into toolkit; new
projects are not added, but reviewing
to ensure concepts are captured in
toolkit
160 J ProjectWants more expansive definition of medical village
using alternative site
Continuing Care Leadership
CoalitionNoted
161 J ProjectPalliative care issues with using UAS; wants more
points for integration into the community
Continuing Care Leadership
CoalitionNoted
162 J. Project Renal Care -- wants different metrics Westchester Medical CenterNote the concern; was addressed
when J was written
MRT
Wai
ver A
men
dmen
t Upd
ate
April
201
4
Jaso
n He
lger
son,
Med
icai
d Di
rect
or
Gre
gory
Alle
n, D
ivis
ion
Dire
ctor
Ka
lin S
cott
, MRT
Pro
ject
Man
ager
O
ffice
of H
ealth
Insu
ranc
e Pr
ogra
ms
NYS
Dep
artm
ent o
f Hea
lth
oM
RT W
aive
r Am
endm
ent:
An O
verv
iew
o
MRT
Wai
ver A
men
dmen
t: St
ate
Plan
Am
endm
ent (
SPA)
o
MRT
Wai
ver A
men
dmen
t: M
anag
ed C
are
oM
RT W
aive
r Am
endm
ent:
DSRI
P Pr
ogra
m O
verv
iew
o
Wha
t Has
Cha
nged
in D
SRIP
?
oDS
RIP
Proj
ect P
lann
ing,
App
licat
ion
Proc
ess &
Ass
essm
ent
oDS
RIP
Dom
ains
: Pla
nnin
g &
Org
aniza
tiona
l Str
uctu
re
oDS
RIP
Proj
ects
o
DSRI
P At
trib
utio
n
PRES
ENTA
TIO
N O
VERV
IEW
2
oDS
RIP
Proj
ect V
alua
tion
oDS
RIP
Proj
ect V
alua
tion
Scen
ario
: Illu
stra
tive
Exam
ple
oDS
RIP
Perf
orm
ance
Ass
essm
ent
oSt
atew
ide
Acco
unta
bilit
y
oDS
RIP
Reso
urce
s o
Inde
pend
ent A
sses
sor a
nd E
valu
ator
o
DSRI
P Ti
mel
ine
o
MRT
Wai
ver A
men
dmen
t Sta
keho
lder
Eng
agem
ent P
roce
ss
PRES
ENTA
TIO
N O
VERV
IEW
(CO
NTI
NU
ED)
3
M
RT W
AIVE
R AM
ENDM
ENT:
AN
OVE
RVIE
W
MRT
WAI
VER
AMEN
DMEN
T
oIn
Apr
il 20
14, G
over
nor A
ndre
w M
. Cuo
mo
anno
unce
d th
at
New
Yor
k St
ate
and
CMS
final
ized
agre
emen
t on
the
MRT
W
aive
r Am
endm
ent.
oAl
low
s the
stat
e to
rein
vest
$8
billi
on o
f the
$17
.1 b
illio
n in
fe
dera
l sav
ings
gen
erat
ed b
y M
RT re
form
s.
oTh
e M
RT W
aive
r Am
endm
ent w
ill:
T
rans
form
the
stat
e’s H
ealth
Car
e Sy
stem
B
end
the
Med
icai
d Co
st C
urve
A
ssur
e Ac
cess
to Q
ualit
y Ca
re fo
r all
Med
icai
d m
embe
rs
5
MRT
WAI
VER
AMEN
DMEN
T: $
8 BI
LLIO
N A
LLO
CATI
ON
o
$500
Mill
ion
for t
he In
terim
Acc
ess
Assu
ranc
e Fu
nd (I
AAF)
– T
ime
limite
d fu
ndin
g to
ens
ure
curr
ent t
rust
ed a
nd v
iabl
e M
edic
aid
safe
ty
net p
rovi
ders
can
fully
par
ticip
ate
in th
e DS
RIP
tran
sfor
mat
ion
with
out
unpr
oduc
tive
disr
uptio
n.
o$6
.42
Billi
on fo
r Del
iver
y Sy
stem
Ref
orm
Ince
ntiv
e Pa
ymen
ts (D
SRIP
) –
Incl
udin
g DS
RIP
Plan
ning
Gra
nts,
DSR
IP P
rovi
der I
ncen
tive
Paym
ents
, an
d DS
RIP
Adm
inist
rativ
e co
sts a
nd D
SRIP
rela
ted
Wor
kfor
ce
Tran
sfor
mat
ion.
o$1
.08
Billi
on fo
r oth
er M
edic
aid
Rede
sign
pur
pose
s –
This
fund
ing
will
su
ppor
t Hea
lth H
ome
deve
lopm
ent,
and
inve
stm
ents
in lo
ng te
rm c
are
wor
kfor
ce a
nd e
nhan
ced
beha
vior
al h
ealth
serv
ices
, (19
15i s
ervi
ces)
.
6
OTH
ER K
EY IN
ITIA
TIVE
S
Oth
er k
ey in
itiat
ives
that
supp
ort M
RT W
aive
r Am
endm
ent
impl
emen
tatio
n in
New
York
:
$1
.2 b
illio
n in
cap
ital i
nves
tmen
t ena
cted
in 2
014-
15
budg
et.
Re
gula
tory
relie
f to
supp
ort p
rovi
der c
olla
bora
tion
on
DSRI
P pr
ojec
ts.
M
ore
info
rmat
ion
to fo
llow
.
7
MRT
WAI
VER
AMEN
DMEN
T
oSt
ayed
true
to th
e or
igin
al g
oals
of th
e M
RT W
aive
r Am
endm
ent
(Aug
ust 2
012)
, whi
le m
akin
g ou
r pro
posa
l con
siste
nt w
ith C
MS
feed
back
on
wha
t cou
ld b
e ap
prov
ed.
oW
hile
the
over
all c
once
pt is
the
sam
e, th
ere
are
a nu
mbe
r of
stru
ctur
al c
hang
es th
at h
ave
been
neg
otia
ted.
The
se in
clud
e:
F
undi
ng Le
vels
S
afet
y N
et D
efin
ition
(for
DSR
IP)
P
rogr
am C
ompo
nent
s
Tim
elin
e
8
MRT
WAI
VER
AMEN
DMEN
T KE
Y DO
CUM
ENTS
MRT
Wai
ver A
men
dmen
t – o
ffici
al g
over
ning
doc
umen
ts:
oPa
rtne
rshi
p Pl
an S
peci
al T
erm
s and
Con
ditio
ns (S
TCs)
Gove
rnin
g ag
reem
ent b
etw
een
New
Yor
k an
d CM
S of
Par
tner
ship
Pla
n 11
15 W
aive
r.
MRT
Wai
ver A
men
dmen
t STC
s out
line
impl
emen
tatio
n of
MRT
Wai
ver A
men
dmen
t pr
ogra
ms,
aut
horiz
ed fu
ndin
g so
urce
s an
d us
es, a
nd o
ther
requ
irem
ents
oAt
tach
men
t I:
Prog
ram
Fun
ding
and
Mec
hani
cs P
roto
col
De
scrib
es th
e st
ate
and
CMS
proc
ess
for r
evie
win
g DS
RIP
proj
ect p
lans
, inc
entiv
e pa
ymen
t met
hodo
logi
es, r
epor
ting
requ
irem
ents
, and
pen
altie
s for
miss
ed
mile
ston
es
oAt
tach
men
t J: S
trat
egie
s and
Met
rics M
enu
De
scrib
es st
rate
gies
and
met
rics a
vaila
ble
to P
erfo
rmin
g Pr
ovid
er S
yste
ms f
or
incl
udin
g in
thei
r DSR
IP P
roje
ct P
lan
9
M
RT W
AIVE
R AM
ENDM
ENT:
ST
ATE
PLAN
AM
ENDM
ENT
(SPA
)
STAT
E PL
AN A
MEN
DMEN
T (S
PA) K
EY C
ON
CEPT
S
oHe
alth
Hom
e De
velo
pmen
t Fun
ds w
ould
supp
ort p
rogr
ams,
in
clud
ing:
Mem
ber E
ngag
emen
t and
Hea
lth H
ome
Prom
otio
n;
W
orkf
orce
Tra
inin
g an
d Re
trai
ning
;
Clin
ical
Con
nect
ivity
- HI
T Im
plem
enta
tion;
and
Join
t Gov
erna
nce
Tech
nica
l Ass
istan
ce a
nd Im
plem
enta
tion
Fund
s.
oHe
alth
Hom
e De
velo
pmen
t Fun
ds w
ill b
e di
strib
uted
thro
ugh
a CM
S ap
prov
ed ra
te a
dd-o
n.
oTo
tal 5
-yea
r val
ue =
$19
0.6
mill
ion.
oM
ore
info
rmat
ion
to fo
llow
.
11
M
RT W
AIVE
R AM
ENDM
ENT:
M
ANAG
ED C
ARE
MAN
AGED
CAR
E CO
NTR
ACT
AMEN
DMEN
TS
oVe
hicl
e to
impl
emen
ting:
1.Lo
ng T
erm
Car
e W
orkf
orce
Str
ateg
y ($
245.
0mm
) 2.
1915
i Ser
vice
s ($
645.
9mm
)
oFu
nds w
ill fl
ow to
pla
ns w
ho w
ill b
e re
quire
d to
con
trac
t fo
r tho
se se
rvic
es.
oPl
ans f
or h
ow fu
nds w
ill b
e us
ed w
ill b
e pr
e-ap
prov
ed b
y th
e st
ate.
o
Tota
l fiv
e ye
ar v
alue
= $
890.
9 m
illio
n.
oM
ore
info
rmat
ion
to fo
llow
.
13
M
RT W
AIVE
R AM
ENDM
ENT:
DE
LIVE
RY S
YSTE
M R
EFO
RM IN
CEN
TIVE
PA
YMEN
T (D
SRIP
) PRO
GRAM
OVE
RVIE
W
DSRI
P KE
Y G
OAL
S RE
MAI
N:
oTr
ansf
orm
atio
n of
the
heal
th c
are
safe
ty n
et a
t bot
h th
e sy
stem
and
stat
e le
vel.
oRe
duci
ng a
void
able
hos
pita
l use
and
impr
ove
othe
r hea
lth
and
publ
ic h
ealth
mea
sure
s at b
oth
the
syst
em a
nd st
ate
leve
l.
oEn
sure
del
iver
y sy
stem
tran
sfor
mat
ion
cont
inue
s bey
ond
the
wai
ver p
erio
d th
roug
h le
vera
ging
man
aged
car
e pa
ymen
t re
form
.
oN
ear t
erm
fina
ncia
l sup
port
for v
ital s
afet
y ne
t pro
vide
rs a
t im
med
iate
risk
of c
losu
re.
15
INTE
RIM
ACC
ESS
ASSU
RAN
CE F
UN
D: S
HORT
TER
M
FIN
ANCI
AL S
UPP
ORT
o
Inte
rim A
cces
s Ass
uran
ce F
und
(IAAF
) is t
empo
rary
, tim
e lim
ited
fund
ing
to p
rote
ct a
gain
st d
egra
datio
n of
the
curr
ent k
ey h
ealth
ca
re se
rvic
es u
ntil
DSRI
P is
impl
emen
ted.
oTo
tal I
AAF
allo
catio
n is
$500
mill
ion
($25
0 m
illio
n fo
r pub
lic
hosp
itals,
$25
0 m
illio
n fo
r non
-pub
lic h
ospi
tals)
.
oTh
e st
ate
will
mak
e al
l dec
ision
s reg
ardi
ng e
ligib
ility
and
di
strib
utio
n, h
owev
er, w
ill b
e lim
ited
to p
rovi
ders
serv
ing
signi
fican
t nu
mbe
rs o
f Med
icai
d m
embe
rs w
ho a
re a
t hig
h fin
anci
al ri
sk.
oAw
arde
es m
ust b
e pa
rt o
f a su
bmitt
ed D
SRIP
app
licat
ion.
oM
ore
info
rmat
ion
to fo
llow
.
16
NYS
DSR
IP P
LAN
: KEY
CO
MPO
NEN
TS
oKe
y fo
cus o
n re
duci
ng a
void
able
hos
pita
lizat
ions
by
25%
ove
r fiv
e ye
ars.
oSt
atew
ide
initi
ativ
e op
en to
larg
e pu
blic
hos
pita
l sys
tem
s and
a w
ide
arra
y of
safe
ty-n
et p
rovi
ders
.
oPa
ymen
ts a
re b
ased
on
perf
orm
ance
on
proc
ess a
nd o
utco
me
mile
ston
es.
o
Prov
ider
s mus
t dev
elop
pro
ject
s bas
ed u
pon
a se
lect
ion
of C
MS
ap
prov
ed p
roje
cts f
rom
eac
h of
thre
e do
mai
ns.
oKe
y th
eme
is co
llabo
ratio
n! C
omm
uniti
es o
f elig
ible
pro
vide
rs w
ill b
e re
quire
d to
wor
k to
geth
er to
dev
elop
DSR
IP p
roje
ct p
ropo
sals.
17
DSRI
P PR
OG
RAM
PRI
NCI
PLES
REM
AIN
•
Impr
ovin
g pa
tient
care
& e
xper
ienc
e th
roug
h a
mor
e ef
ficie
nt, p
atie
nt-c
ente
red
and
coor
dina
ted
syst
em.
Patie
nt-C
ente
red
•De
cisio
n m
akin
g pr
oces
s ta
kes p
lace
in th
e pu
blic
eye
an
d th
at p
roce
sses
are
cle
ar a
nd a
ligne
d ac
ross
pr
ovid
ers.
Tr
ansp
aren
t
•Co
llabo
rativ
e pr
oces
s ref
lect
s the
nee
ds o
f the
co
mm
uniti
es a
nd in
puts
of s
take
hold
ers.
Co
llabo
rativ
e
•Pr
ovid
ers a
re h
eld
to c
omm
on p
erfo
rman
ce
stan
dard
s, d
eliv
erab
les a
nd ti
mel
ines
. Ac
coun
tabl
e
•Fo
cus o
n in
crea
sing
valu
e to
pat
ient
s, co
mm
unity
, pa
yers
and
oth
er st
akeh
olde
rs.
Valu
e Dr
iven
Bett
er c
are,
less
cost
18
PERF
ORM
ING
PRO
VIDE
R SY
STEM
S (P
PS):
LOCA
L PA
RTN
ERSH
IPS
TO T
RAN
SFO
RM T
HE D
ELIV
ERY
SYST
EM
Part
ners
shou
ld in
clud
e:
Ho
spita
ls
Heal
th H
omes
Skill
ed N
ursin
g Fa
cilit
ies
Cl
inic
s & F
QHC
s
Beha
vior
al H
ealth
Pro
vide
rs
Ho
me
Care
Age
ncie
s
Oth
er K
ey S
take
hold
ers
Com
mun
ity h
ealth
car
e ne
eds a
sses
smen
t bas
ed
on m
ulti-
stak
ehol
der i
nput
and
obj
ectiv
e da
ta.
Build
ing
and
impl
emen
ting
a DS
RIP
Proj
ect
Plan
bas
ed u
pon
the
need
s ass
essm
ent i
n al
ignm
ent w
ith D
SRIP
stra
tegi
es.
Mee
ting
and
repo
rtin
g on
DSR
IP P
roje
ct P
lan
proc
ess a
nd o
utco
me
mile
ston
es.
Resp
onsi
bilit
ies m
ust i
nclu
de:
19
W
HAT
HAS
CHAN
GED
IN D
SRIP
?
Safe
ty N
et D
efin
ition
Fu
rthe
r Spe
cific
atio
ns o
f Key
Com
pone
nts
DSRI
P Ti
mel
ine
SAFE
TY N
ET D
EFIN
ITIO
N (H
OSP
ITAL
S)
oA
hosp
ital m
ust m
eet o
ne o
f the
thre
e fo
llow
ing
crite
ria to
pa
rtic
ipat
e in
a p
erfo
rmin
g pr
ovid
er sy
stem
:
1)M
ust b
e ei
ther
a p
ublic
hos
pita
l, Cr
itica
l Acc
ess H
ospi
tal o
r So
le C
omm
unity
Hos
pita
l,
O
R …
21
SAFE
TY N
ET D
EFIN
ITIO
N (H
OSP
ITAL
S)
2)M
ust p
ass t
wo
test
s:
a)At
leas
t 35
perc
ent o
f all
patie
nt v
olum
e in
thei
r ou
tpat
ient
line
s of b
usin
ess m
ust b
e as
soci
ated
with
M
edic
aid,
uni
nsur
ed a
nd D
ual E
ligib
le in
divi
dual
s.
b)At
leas
t 30
perc
ent o
f inp
atie
nt tr
eatm
ent m
ust b
e as
soci
ated
with
Med
icai
d, u
nins
ured
and
Dua
l Elig
ible
in
divi
dual
s;
OR
…
22
SAFE
TY N
ET D
EFIN
ITIO
N (H
OSP
ITAL
S)
O
R …
3)M
ust s
erve
at l
east
30
perc
ent o
f all
Med
icai
d,
unin
sure
d an
d Du
al E
ligib
le m
embe
rs in
the
prop
osed
co
unty
or m
ulti-
coun
ty c
omm
unity
. The
stat
e w
ill u
se
Med
icai
d cl
aim
s and
enc
ount
er d
ata
as w
ell a
s oth
er
sour
ces t
o ve
rify
this
clai
m. T
he st
ate
rese
rves
the
right
to
incr
ease
this
perc
enta
ge o
n a
case
by
case
bas
is so
as
to e
nsur
e th
at th
e ne
eds o
f eac
h co
mm
unity
’s M
edic
aid
mem
bers
are
met
.
23
SAFE
TY N
ET D
EFIN
ITIO
N (N
ON
-HO
SPIT
AL B
ASED
PR
OVI
DERS
& N
ON
-QUA
LIFY
ING
DSR
IP P
ROVI
DERS
)
oN
on-h
ospi
tal b
ased
pro
vide
rs, n
ot p
artic
ipat
ing
as p
art o
f a st
ate-
desig
nate
d He
alth
Hom
e, m
ust h
ave
at le
ast 3
5 pe
rcen
t of a
ll pa
tient
vo
lum
e in
thei
r prim
ary
lines
of b
usin
ess a
ssoc
iate
d w
ith M
edic
aid,
un
insu
red
and
Dual
Elig
ible
indi
vidu
als.
oN
on-q
ualif
ying
pro
vide
rs, c
an p
artic
ipat
e in
Per
form
ing
Prov
ider
s Sy
stem
s. H
owev
er, n
o m
ore
than
5 p
erce
nt o
f a p
roje
ct’s
tota
l va
luat
ion
may
be
paid
to n
on-q
ualif
ying
pro
vide
rs. T
his 5
per
cent
lim
it ap
plie
s to
non-
qual
ifyin
g pr
ovid
ers a
s a g
roup
. CM
S ca
n ap
prov
e pa
ymen
ts a
bove
this
amou
nt if
it is
dee
med
in th
e be
st
inte
rest
of M
edic
aid
mem
bers
att
ribut
ed to
the
Perf
orm
ing
Prov
ider
Sy
stem
.
24
SAFE
TY N
ET D
EFIN
ITIO
N
(VIT
AL A
CCES
S PR
OVI
DER
EXCE
PTIO
N)
Vita
l Acc
ess P
rovi
der E
xcep
tion:
The
stat
e w
ill c
onsid
er e
xcep
tions
to th
e sa
fety
net
def
initi
on o
n a
case
-by-
case
bas
is if
it is
deem
ed in
the
best
in
tere
st o
f Med
icai
d m
embe
rs. A
ny e
xcep
tions
that
are
con
sider
ed m
ust
be a
ppro
ved
by C
MS
and
mus
t be
post
ed fo
r pub
lic c
omm
ent 3
0 da
ys
prio
r to
appl
icat
ion
appr
oval
. Thr
ee a
llow
ed re
ason
s for
gra
ntin
g an
ex
cept
ion
are:
A
com
mun
ity w
ill n
ot b
e se
rved
with
out g
rant
ing
the
exce
ptio
n be
caus
e no
oth
er
elig
ible
pro
vide
r is w
illin
g or
cap
able
of s
ervi
ng th
e co
mm
unity
.
An
y ho
spita
l is u
niqu
ely
qual
ified
to se
rve
base
d on
serv
ices
pro
vide
d, fi
nanc
ial
viab
ility
, rel
atio
nshi
ps w
ithin
the
com
mun
ity, a
nd/o
r cle
ar tr
ack
reco
rd o
f suc
cess
in
redu
cing
avo
idab
le h
ospi
tal u
se.
An
y st
ate-
desig
nate
d He
alth
Hom
e or
gro
up o
f Hea
lth H
omes
.
25
DSRI
P TE
RMIN
OLO
GY
oPr
ovid
ers t
hat f
orm
par
tner
ship
s and
col
labo
rate
in a
DSR
IP P
roje
ct
Plan
are
now
refe
rred
to a
s a P
erfo
rmin
g Pr
ovid
er S
yste
m (P
PS).
oTh
e DS
RIP
prog
ram
con
tain
s fou
r eva
luat
ion
Dom
ains
. Dom
ains
2
and
3 ar
e fu
rthe
r bro
ken
into
spec
ific
stra
tegy
are
as. U
nder
eac
h st
rate
gy a
re a
num
ber o
f pro
ject
s.
Dom
ains
Stra
tegi
es
Proj
ects
DSRI
P Pr
ojec
t Pla
n
Perf
orm
ing
Prov
ider
Sys
tem
26
UPD
ATED
DSR
IP P
ROJE
CT T
IMEL
INE
Plan
ning
, Ass
essm
ent &
Pro
ject
Dev
elop
men
t (Ap
ril 2
014
– M
arch
201
5)
Pr
ojec
t Pla
n Ap
plic
atio
ns D
ue D
ecem
ber 2
014
Proj
ect I
mpl
emen
tatio
n
(DY1
Sta
rts A
pril
2015
)
Perf
orm
ance
Eva
luat
ion
& M
easu
rem
ent
(Pla
n ad
just
men
ts a
s nee
ded)
Met
ric &
Mile
ston
es A
chie
vem
ent
D Y 1 - 5
D Y 0
27
DS
RIP
PRO
JECT
PLA
NN
ING,
APP
LICA
TIO
N
PRO
CESS
& A
SSES
SMEN
T (Y
EAR
0)
DSRI
P PR
OJE
CT P
LAN
REQ
UIR
EMEN
TS
The
proj
ect m
ust b
e:
oA
new
initi
ativ
e fo
r the
Per
form
ing
Prov
ider
Sys
tem
(PPS
);
oSu
bsta
ntia
lly d
iffer
ent f
rom
oth
er in
itiat
ives
fund
ed b
y CM
S,
alth
ough
it m
ay b
uild
on
or a
ugm
ent s
uch
an in
itiat
ive;
o
Docu
men
ted
to a
ddre
ss o
ne o
r mor
e sig
nific
ant i
ssue
s with
in th
e PP
S se
rvic
e ar
ea a
nd b
e ba
sed
on a
det
aile
d an
alys
is us
ing
obje
ctiv
e da
ta so
urce
s;
oA
subs
tant
ial,
tran
sfor
mat
ive
chan
ge fo
r the
PPS
;
29
DSRI
P PR
OJE
CT P
LAN
REQ
UIR
EMEN
TS
oDe
mon
stra
tive
of a
com
mitm
ent t
o lif
e-cy
cle
chan
ge a
nd a
w
illin
gnes
s to
com
mit
suffi
cien
t org
aniza
tiona
l res
ourc
es to
en
surin
g pr
ojec
t suc
cess
;
oDe
velo
ped,
in c
once
rt, w
ith o
ther
pro
vide
rs in
the
serv
ice
area
with
spec
ial a
tten
tion
paid
to c
oord
inat
ion
with
Hea
lth
Hom
es a
ctiv
ely
wor
king
with
in th
eir a
rea;
and
oAp
plic
atio
ns fr
om si
ngle
pro
vide
rs w
ill n
ot b
e co
nsid
ered
!
30
DSRI
P PR
OJE
CT D
ESIG
N G
RAN
T RE
VIEW
AN
D AP
PRO
VAL
PRO
CESS
1.
Pro
vide
r Sub
mits
Pr
ojec
t Des
ign
Gra
nt A
pplic
atio
n
•El
igib
le p
rovi
der c
olla
bora
tions
wish
ing
to
part
icip
ate
in D
SRIP
will
subm
it a
com
plet
ed p
roje
ct
desig
n gr
ant a
pplic
atio
n to
the
stat
e by
the
spec
ified
dea
dlin
e.
2. S
tate
Rev
iew
s Pr
ojec
t Des
ign
Gra
nt
Appl
icat
ion
•St
ate
will
initi
ate
a pr
elim
inar
y re
view
of a
ll pr
ojec
t de
sign
gran
t app
licat
ions
usin
g a
deve
lope
d ch
eckl
ist to
ens
ure
that
app
licat
ions
mee
t bas
elin
e pl
anni
ng re
quire
men
ts. F
irst p
aym
ent s
ent o
ut
upon
pla
nnin
g gr
ant a
ppro
val.
3. P
rovi
der s
ubm
its
Year
0 P
lann
ing
Prog
ress
Rep
ort t
o DO
H
•Al
l app
rove
d pr
ojec
t des
ign
gran
t app
lican
ts w
ill
have
to su
bmit
an u
pdat
ed re
port
to th
e st
ate
on
its p
rogr
ess o
n de
velo
ping
a D
SRIP
Pro
ject
Pla
n.
31
DSRI
P PR
OJE
CT R
EVIE
W A
ND
APPR
OVA
L PR
OCE
SS
4. P
rovi
der s
ubm
its
a DS
RIP
Proj
ect P
lan
to D
OH
(Dec
201
4)
•Pr
ovid
ers w
ill su
bmit
DSRI
P Pr
ojec
t Pla
n to
DO
H w
hich
un
derg
o a
final
revi
ew b
y an
inde
pend
ent a
sses
sor a
s wel
l as
a pa
nel o
f out
side
non-
conf
licte
d in
depe
nden
t hea
lth c
are
entit
ies a
nd c
onsu
mer
adv
ocat
es.
A re
view
tool
use
d by
the
pane
l will
be
publ
ished
prio
r to
the
proj
ect p
lan
subm
issio
n da
te to
ass
ist p
rovi
ders
in d
evel
opin
g th
eir s
ubm
issio
n. A
fe
edba
ck lo
op w
ill b
e bu
ilt in
to a
llow
pla
n an
d/or
net
wor
k im
prov
emen
t.
5. F
inal
Not
ifica
tion
•Pr
ovid
ers w
ill b
e no
tifie
d of
the
revi
ew o
utco
me.
Pro
vide
rs
who
hav
e pr
ojec
ts a
ppro
ved
can
begi
n th
e im
plem
enta
tion
of th
eir D
SRIP
Pro
ject
des
ign
gran
t in
Year
1.
32
DS
RIP
DOM
AIN
S: P
LAN
NIN
G &
O
RGAN
IZAT
ION
AL S
TRU
CTU
RE
DSRI
P DO
MAI
NS
Proj
ect i
mpl
emen
tatio
n is
divi
ded
into
four
Dom
ains
for p
roje
ct se
lect
ion
and
repo
rtin
g:
D
omai
n 1
– O
vera
ll Pr
ojec
t Pro
gres
s
Dom
ain
2 –
Syst
em T
rans
form
atio
n
Dom
ain
3 –
Clin
ical
Impr
ovem
ent
D
omai
n 4
– Po
pula
tion-
wid
e St
rate
gy Im
plem
enta
tion
– Th
e
P
reve
ntio
n Ag
enda
Thro
ugh
inno
vatio
ns in
thes
e fo
ur d
omai
ns, t
he st
atew
ide
DSRI
P pl
an is
de
signe
d to
redu
ce a
void
able
hos
pita
lizat
ions
by
25%
ove
r fiv
e ye
ars.
34
DSRI
P DO
MAI
NS
Dom
ain
1: O
vera
ll Pr
ojec
t Pro
gres
s o
Inve
stm
ents
in te
chno
logy
, too
ls, a
nd h
uman
reso
urce
s tha
t will
st
reng
then
the
abili
ty o
f the
Per
form
ing
Prov
ider
s Sys
tem
s (PP
S) to
se
rve
targ
et p
opul
atio
ns a
nd p
ursu
e DS
RIP
proj
ect g
oals.
oPe
rfor
min
g Pr
ovid
ers S
yste
ms (
PPS)
will
nee
d to
subm
it a
deta
iled
proj
ect p
lan
for i
mpl
emen
tatio
n of
thei
r cho
sen
proj
ect.
oPe
rfor
man
ce in
this
dom
ain
will
be
mea
sure
d on
mee
ting
iden
tifie
d m
ilest
ones
in th
e pr
ojec
t pla
n an
d pr
ogre
ss to
sust
aina
bilit
y.
35
DSRI
P DO
MAI
NS
Dom
ain
2: S
yste
m T
rans
form
atio
n o
Proj
ects
in th
is do
mai
n fo
cus o
n sy
stem
tran
sfor
mat
ion
and
fall
into
th
ree
stra
tegy
subl
ists:
A.
Crea
te in
tegr
ated
del
iver
y sy
stem
B.
Impl
emen
tatio
n of
car
e co
ordi
natio
n an
d tr
ansit
iona
l car
e pr
ogra
ms
C.Co
nnec
ting
syst
em
oAl
l PPS
mus
t sel
ect a
t lea
st tw
o pr
ojec
ts (a
nd u
p to
four
pro
ject
s)
from
Dom
ain
2:
At
leas
t one
pro
ject
mus
t be
from
stra
tegy
subl
ist A
(see
att
achm
ent J
)
At le
ast o
ne p
roje
ct m
ust b
e fr
om st
rate
gy su
blist
B o
r C (s
ee a
ttac
hmen
t J)
o
Met
rics w
ill in
clud
e av
oida
ble
hosp
italiz
atio
ns a
nd o
ther
mea
sure
s of
syst
em tr
ansf
orm
atio
n.
36
DSRI
P DO
MAI
NS
Dom
ain
3: C
linic
al Im
prov
emen
t o
Proj
ects
in th
is do
mai
n fo
cus o
n cl
inic
al im
prov
emen
t for
ce
rtai
n pr
iorit
y di
seas
e ca
tego
ries.
oAl
l PPS
mus
t sel
ect a
t lea
st tw
o (b
ut n
o m
ore
than
four
) pr
ojec
ts fr
om D
omai
n 3:
At l
east
one
pro
ject
mus
t be
from
stra
tegy
subl
ist A
(beh
avio
ral h
ealth
)
oM
etric
s will
incl
ude
dise
ase
focu
sed
natio
nally
reco
gnize
d an
d va
lidat
ed m
etric
s, g
ener
ally
from
HED
IS.
37
DSRI
P DO
MAI
NS
Dom
ain
4: P
opul
atio
n-w
ide
Stra
tegy
Impl
emen
tatio
n o
Proj
ects
in th
is do
mai
n ar
e al
igne
d to
the
NYS
Pre
vent
ion
Agen
da a
nd
shou
ld a
lign
with
pro
ject
s in
Dom
ain
3.
oPe
rfor
min
g Pr
ovid
er S
yste
ms w
ill s
elec
t one
(but
no
mor
e th
an tw
o)
proj
ects
from
at l
east
one
of t
he fo
ur p
riorit
y ar
eas:
Prom
ote
Men
tal H
ealth
and
Pre
vent
Sub
stan
ce A
buse
;
Prev
ent C
hron
ic D
isea
se;
Pr
even
t HIV
/AID
S; a
nd
Pr
omot
e He
alth
Wom
en, I
nfan
ts a
nd C
hild
ren.
oRe
port
ing
will
be
on p
rogr
ess P
PS h
ave
mad
e in
impl
emen
ting
the
alig
ned
stra
tegi
es.
oLi
nk to
the
New
Yor
k St
ate
Prev
entio
n Ag
enda
: (h
ttp:
//w
ww
.hea
lth.n
y.go
v/pr
even
tion/
prev
entio
n_ag
enda
/201
3-20
17/in
dex.
htm
)
38
DS
RIP
PRO
JECT
S
DSRI
P PR
OJE
CTS
oSa
fety
net
pro
vide
rs m
ust c
hose
a sp
ecifi
ed n
umbe
r of p
roje
cts
from
Dom
ains
2, 3
and
4.
oEa
ch p
roje
ct h
as th
e fo
llow
ing
com
pone
nts s
peci
fical
ly ti
ed to
the
goal
of r
educ
ing
avoi
dabl
e ho
spita
lizat
ions
:
Cl
early
def
ined
pro
cess
mea
sure
s;
Cl
early
def
ined
out
com
e m
easu
res;
Cl
early
def
ined
mea
sure
s of s
ucce
ss re
leva
nt to
pro
vide
r typ
e an
d po
pula
tion
impa
cted
; and
Cl
early
def
ined
fina
ncia
l sus
tain
abili
ty m
etric
s to
asse
ss lo
ng-te
rm
viab
ility
.
40
DOM
AIN
2: S
YSTE
M T
RAN
SFO
RMAT
ION
ST
RATE
GY A
REA:
INTE
GRA
TED
DELI
VERY
SYS
TEM
S
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
2.a.
i Cr
eate
Inte
grat
ed D
eliv
ery
Syst
ems t
hat a
re
focu
sed
on E
vide
nce
Base
d M
edic
ine
/ Po
pula
tion
Heal
th M
anag
emen
t
56
2.a.
ii In
crea
se c
ertif
icat
ion
of p
rimar
y ca
re
prac
titio
ners
with
PCM
H ce
rtifi
catio
n an
d/or
Ad
vanc
ed P
rimar
y Ca
re M
odel
s (as
dev
elop
ed
unde
r the
New
York
Sta
te H
ealth
Inno
vatio
n Pl
an
[SHI
P])
37
A. C
reat
e In
tegr
ated
Del
iver
y Sy
stem
s (Re
quire
d)
41
*Ind
ex S
core
: An
eva
luat
ion
or sc
ore
assig
ned
to D
SRIP
pro
ject
s, b
ased
on
five
elem
ents
(1. P
oten
tial f
or a
chie
ving
syst
em
tran
sfor
mat
ion,
2. P
oten
tial f
or re
duci
ng p
reve
ntab
le e
vent
, 3. %
of M
edic
aid
bene
ficia
ries a
ffect
ed b
y pr
ojec
t, 4.
Pot
entia
l Co
st S
avin
gs a
nd 5
. Rob
ustn
ess o
f Evi
denc
e Ba
sed
sugg
estio
ns).
Proj
ect i
ndex
scor
es a
re se
t by
the
stat
e an
d ar
e re
leas
ed
prio
r to
the
appl
icat
ion
perio
d.
DOM
AIN
2: S
YSTE
M T
RAN
SFO
RMAT
ION
ST
RATE
GY A
REA:
INTE
GRA
TED
DELI
VERY
SYS
TEM
S
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
2.a.
iii
Heal
th H
ome
At R
isk In
terv
entio
n Pr
ogra
m–
Proa
ctiv
e m
anag
emen
t of h
ighe
r risk
pat
ient
s not
cu
rren
tly e
ligib
le fo
r Hea
lth H
omes
thro
ugh
acce
ss to
hig
h qu
ality
prim
ary
care
and
supp
ort
serv
ices
.
46
2.a.
iv
Crea
te a
med
ical
vill
age
usin
g ex
istin
g ho
spita
l in
fras
truc
ture
. 54
2.a.
v Cr
eate
a m
edic
al v
illag
e/ a
ltern
ativ
e ho
usin
g us
ing
exist
ing
nurs
ing
hom
e.
42
A. C
reat
e In
tegr
ated
Del
iver
y Sy
stem
s (Re
quire
d)
42
DOM
AIN
2: S
YSTE
M T
RAN
SFO
RMAT
ION
STR
ATEG
Y AR
EA:
CARE
CO
ORD
INAT
ION
& T
RAN
SITI
ON
AL C
ARE
PRO
GRA
MS
B. Im
plem
enta
tion
of c
are
coor
dina
tion
and
tran
sitio
nal c
are
prog
ram
s
43
Proj
ect #
D
escr
iptio
n In
dex
Scor
e *
(out
of 6
0 pt
s)
2.b.
i Am
bula
tory
ICU
s 36
2.b.
ii
Deve
lopm
ent o
f co-
loca
ted
of p
rimar
y ca
re
serv
ices
in th
e em
erge
ncy
depa
rtm
ent (
ED)
40
2.b.
iii
ED ca
re tr
iage
for a
t-ris
k po
pula
tions
43
2.b.
iv
Care
tran
sitio
ns in
terv
entio
n m
odel
to re
duce
30
day
read
miss
ions
for c
hron
ic h
ealth
con
ditio
ns
43
2.b.
v Ca
re tr
ansit
ions
inte
rven
tion
for s
kille
d nu
rsin
g fa
cilit
y re
siden
ts
41
2.b.
vi
Tran
sitio
nal s
uppo
rtiv
e ho
usin
g se
rvic
es
47
2.b.
vii
Impl
emen
ting
the
INTE
RACT
pro
ject
(inp
atie
nt
tran
sfer
avo
idan
ce p
rogr
am fo
r SN
F)
41
2.b.
viii
Hosp
ital-H
ome
Care
Col
labo
ratio
n So
lutio
ns
45
2.b.
ix
Impl
emen
tatio
n of
obs
erva
tiona
l pro
gram
s in
hosp
itals
36
DOM
AIN
2: S
YSTE
M T
RAN
SFO
RMAT
ION
ST
RATE
GY A
REA:
CO
NN
ECTI
NG
SET
TIN
GS
Proj
ect #
D
escr
iptio
n In
dex
Scor
e *
(out
of 6
0 pt
s)
2.c.
i De
velo
pmen
t of c
omm
unity
-bas
ed h
ealth
na
viga
tion
serv
ices
37
2.c.
ii
Expa
nd u
sage
of t
elem
edic
ine
in u
nder
serv
ed
area
s to
prov
ide
acce
ss
to o
ther
wise
scar
ce
serv
ices
31
C. C
onne
ctin
g Se
ttin
gs
44
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
A: B
EHAV
IORA
L HE
ALTH
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
3.a.
i In
tegr
atio
n of
prim
ary
care
serv
ices
and
be
havi
oral
hea
lth
39
3.a.
ii
Beha
vior
al h
ealth
com
mun
ity c
risis
stab
iliza
tion
serv
ices
37
3. a
.iii
Impl
emen
tatio
n of
evi
denc
e ba
sed
med
icat
ion
adhe
renc
e pr
ogra
m (M
AP) i
n co
mm
unity
bas
ed
sites
for b
ehav
iora
l hea
lth m
edic
atio
n co
mpl
ianc
e.
29
3.a.
iv
Deve
lopm
ent o
f with
draw
al m
anag
emen
t (a
mbu
lato
ry d
etox
ifica
tion)
cap
abili
ties
with
in
com
mun
ities
.
36
3.a.
v
Beha
vior
al In
terv
entio
ns P
arad
igm
in N
ursin
g Ho
mes
(BIP
NH)
. 40
A. B
ehav
iora
l hea
lth (r
equi
red)
45
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
A: C
ARDI
OVA
SCU
LAR
HEAL
TH
B. C
ardi
ovas
cula
r Hea
lth
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
3.b.
i Ev
iden
ce b
ased
stra
tegi
es fo
r dise
ase
man
agem
ent i
n hi
gh ri
sk/a
ffect
ed
popu
latio
ns (a
dult
only
)
30
3.b.
ii
Impl
emen
tatio
n of
evi
denc
e-ba
sed
stra
tegi
es in
the
com
mun
ity to
add
ress
ch
roni
c di
seas
e --
prim
ary
and
seco
ndar
y pr
even
tion
proj
ects
(adu
lt on
ly)
26
(PPS
shou
ld u
tilize
stra
tegi
es c
onta
ined
in th
e M
illio
n He
arts
cam
paig
n as
ap
prop
riate
.)
46
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
A: D
IABE
TES
CARE
C.
Dia
bete
s Car
e
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
3.c.
i Ev
iden
ce-b
ased
str
ateg
ies f
or d
iseas
e m
anag
emen
t in
high
risk
/affe
cted
po
pula
tions
(adu
lts o
nly)
30
3.c.
ii
Impl
emen
tatio
n of
evi
denc
e-ba
sed
stra
tegi
es in
the
com
mun
ity to
add
ress
ch
roni
c di
seas
e –
prim
ary
and
seco
ndar
y
prev
entio
n pr
ojec
ts (a
dults
onl
y)
26
47
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
AS: A
STHM
A
Proj
ect #
D
escr
iptio
n In
dex
Scor
e *
(out
of 6
0 pt
s)
3.d.
i De
velo
pmen
t of e
vide
nce-
base
d m
edic
atio
n ad
here
nce
pro
gram
s (M
AP) i
n co
mm
unity
se
ttin
gs –
asth
ma
med
icat
ion
28
3.d.
ii
Expa
nsio
n of
ast
hma
hom
e-ba
sed
self-
man
agem
ent p
rogr
am
31
3.d.
iii
Evid
ence
bas
ed m
edic
ine
guid
elin
es fo
r as
thm
a m
anag
emen
t 31
D. A
sthm
a
48
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
AS: H
IV
E. H
IV
Proj
ect #
D
escr
iptio
n In
dex
Scor
e* (o
ut o
f 60
pts)
3.
e.i
Com
preh
ensiv
e St
rate
gy to
dec
reas
e HI
V/AI
DS tr
ansm
issio
n to
redu
ce a
void
able
ho
spita
lizat
ions
– d
evel
opm
ent o
f a C
ente
r of
Exc
elle
nce
for m
anag
emen
t of H
IV/A
IDS.
28
49
DOM
AIN
3: C
LIN
ICAL
IMPR
OVE
MEN
T PR
OJE
CTS
STRA
TEGY
ARE
AS: P
ERIN
ATAL
/ P
ALLI
ATIV
E /
REN
AL
Proj
ect #
D
escr
iptio
n In
dex
Scor
e
3.f.i
In
crea
se su
ppor
t pro
gram
s for
mat
erna
l &
child
hea
lth (
incl
udin
g hi
gh ri
sk p
regn
anci
es)
(Exa
mpl
e: N
urse
-Fam
ily
Part
ners
hip)
29
Proj
ect #
D
escr
iptio
n In
dex
Scor
e
3.g.
i IH
I “Co
nver
satio
n Re
ady”
mod
el
29
3.g.
ii In
tegr
atio
n of
pal
liativ
e ca
re in
to m
edic
al
hom
es
22
3.g.
iii
Inte
grat
ion
of p
allia
tive
care
into
nur
sing
hom
es
25
Proj
ect #
D
escr
iptio
n In
dex
Scor
e
3.h.
i Sp
ecia
lized
Med
ical
Hom
e fr
om C
hron
ic
Rena
l Fai
lure
29
F. P
erin
atal
G. P
allia
tive
H. R
enal
50
DOM
AIN
4:
POPU
LATI
ON
-WID
E PR
OJE
CTS
STRA
TEGY
ARE
AS: M
H &
SU
D/CH
RON
IC D
ISEA
SE/
HIV
& S
TDS
/ W
IC
The
follo
win
g re
pres
ent p
riorit
ies f
rom
the
Stat
e’s P
reve
ntio
n Ag
enda
. At
leas
t one
pro
ject
from
this
dom
ain
mus
t be
chos
en, b
ased
upo
n th
e co
mm
unity
ass
essm
ent:
A.
Prom
ote
Men
tal H
ealth
and
Pre
vent
Sub
stan
ce A
buse
51
Proj
ect #
D
escr
iptio
n In
dex
Scor
e *
(out
of 6
0 pt
s)
4.a.
i. Pr
omot
e m
enta
l, em
otio
nal a
nd b
ehav
iora
l (M
EB) w
ell-b
eing
in c
omm
uniti
es
23
4.a.
ii.
Prev
ent S
ubst
ance
Abu
se a
nd o
ther
Men
tal
Emot
iona
l Beh
avio
ral D
isord
ers
20
4.a.
iii
Stre
ngth
en M
enta
l Hea
lth a
nd S
ubst
ance
Ab
use
Infr
astr
uctu
re a
cros
s Sys
tem
s 20
DOM
AIN
4:
POPU
LATI
ON
-WID
E PR
OJE
CTS
STRA
TEGY
ARE
AS: M
H &
SU
D/CH
RON
IC D
ISEA
SE/
HIV
& S
TDS
/ W
IC
B.Pr
even
t Chr
onic
Dis
ease
s
52
Proj
ect #
D
escr
iptio
n In
dex
Scor
e *
(out
of 6
0 pt
s)
4.b.
i. Pr
omot
e to
bacc
o us
e ce
ssat
ion,
esp
ecia
lly
amon
g lo
w S
ES p
opul
atio
ns a
nd th
ose
with
po
or m
enta
l hea
lth.
23
4.b.
ii.
Incr
ease
Acc
ess t
o Hi
gh Q
ualit
y Ch
roni
c Di
seas
e Pr
even
tive
Care
and
Man
agem
ent i
n Bo
th C
linic
al a
nd C
omm
unity
Set
tings
.
17
DOM
AIN
4:
POPU
LATI
ON
-WID
E PR
OJE
CTS
STRA
TEGY
ARE
AS: M
H &
SU
D/CH
RON
IC D
ISEA
SE/
HIV
& S
TDS
/ W
IC
53
Proj
ect #
De
scrip
tion
Inde
x Sc
ore
* (o
ut o
f 60
pts)
4.c.
i De
crea
se H
IV m
orbi
dity
; 19
4.c.
ii In
crea
se e
arly
acc
ess t
o, a
nd re
tent
ion
in,
HIV
care
; 19
4.c.
iii
Decr
ease
STD
mor
bidi
ty; a
nd
15
4.c.
iv
Decr
ease
HIV
and
STD
Disp
ariti
es
18
Proj
ect #
De
scrip
tion
Inde
x Sc
ore
* (o
ut o
f 60
pts)
4.d.
i Re
duce
Pre
mat
ure
Birt
hs
24
The
follo
win
g re
pres
ent p
riorit
ies f
rom
the
Stat
e’s P
reve
ntio
n Ag
enda
. At
leas
t one
pr
ojec
t fro
m th
is do
mai
n m
ust b
e ch
osen
, bas
ed u
pon
the
com
mun
ity a
sses
smen
t:
C.Pr
even
t HIV
and
STD
s
D.
Prom
ote
Hea
lthy
Wom
en, I
nfan
ts a
nd C
hild
ren
The
follo
win
g fo
ur m
easu
res w
ill b
e us
ed to
eva
luat
e DS
RIP’
s su
cces
s in
redu
cing
avo
idab
le h
ospi
tal u
se:
Po
tent
ially
Pre
vent
able
Em
erge
ncy
Room
Visi
ts (P
PVs)
.
Po
tent
ially
Pre
vent
able
Rea
dmiss
ions
(PPR
s).
Pr
even
tion
Qua
lity
Indi
cato
rs- A
dult
(PQ
Is).
Pr
even
tion
Qua
lity
Indi
cato
rs- P
edia
tric
(PDI
s),
DSRI
P PE
RFO
RMAN
CE M
EASU
RES:
DO
MAI
N 2
- AV
OID
ABLE
HO
SPIT
ALIZ
ATIO
NS
54
Oth
er m
easu
res w
ill b
e us
ed to
mon
itor s
yste
m tr
ansf
orm
atio
n an
d fis
cal s
tabi
lity:
%
Alte
rnat
e pa
ymen
t str
ateg
ies i
n M
edic
aid
Sy
stem
Inte
grat
ion
mea
sure
s
PC
MH
Atta
inm
ent
Ac
cess
to ca
re m
easu
res
Ca
re tr
ansit
ions
mea
sure
s
DSRI
P PE
RFO
RMAN
CE M
EASU
RES:
DO
MAI
N 2
- SY
STEM
TRA
NSF
ORM
ATIO
N
55
Each
Dom
ain
3 st
rate
gy h
as a
ssig
ned
met
rics s
peci
fic to
the
stra
tegy
subj
ect.
For e
xam
ple,
for A
. Beh
avio
ral H
ealth
, the
se in
clud
e:
An
tidep
ress
ant M
edic
atio
n M
anag
emen
t.
Fo
llow
-up
afte
r hos
pita
lizat
ion
for M
enta
l Illn
ess (
NCQ
A).
Ca
rdio
vasc
ular
mon
itorin
g fo
r Peo
ple
with
CVD
and
Sc
hizo
phre
nia.
Not
e: M
etric
s are
chos
en fr
om n
atio
nally
reco
gnize
d, v
alid
ated
m
easu
res.
DSRI
P PE
RFO
RMAN
CE M
EASU
RES:
DO
MAI
N 3
– C
LIN
ICAL
IMPR
OVE
MEN
T
56
Dom
ain
4 m
easu
res a
re th
ose
alre
ady
mea
sure
d by
the
stat
e in
th
e Pr
even
tion
Agen
da a
nd in
clud
e th
e to
tal p
opul
atio
n fo
r the
PP
S ar
ea (n
ot ju
st M
edic
aid
Mem
bers
). A
s exa
mpl
es:
Pe
rcen
tage
of a
dults
who
are
obe
se
Ag
e-ad
just
ed h
eart
att
ack
hosp
italiz
atio
n ra
te p
er 1
0,00
0
Pe
rcen
tage
of p
rem
atur
e de
ath
(bef
ore
age
65)
•Ra
tio o
f Bla
ck n
on-H
ispan
ics
to W
hite
non
-Hisp
anic
s
• R
atio
of H
ispan
ics
to W
hite
non
-Hisp
anic
s
DSRI
P PE
RFO
RMAN
CE M
EASU
RES:
DO
MAI
N 4
– P
OPU
LATI
ON
WID
E
57
DS
RIP
ATTR
IBU
TIO
N
DSRI
P AT
TRIB
UTI
ON
: MAT
CHIN
G M
EMBE
RS T
O A
PPS
oAt
trib
utio
n is
the
proc
ess u
sed
in D
SRIP
to a
ssig
n a
mem
ber t
o a
Perf
orm
ing
Prov
ider
Sys
tem
(PPS
).
oAt
trib
utio
n m
akes
sure
that
eac
h M
edic
aid
mem
ber i
s ass
igne
d to
on
e an
d on
ly o
ne P
PS.
oAt
trib
utio
n us
es g
eogr
aphy
, pat
ient
visi
t inf
orm
atio
n an
d he
alth
pl
an P
CP a
ssig
nmen
t to
“att
ribut
e” a
mem
ber t
o a
give
n PP
S.
oPa
tient
visi
t inf
orm
atio
n is
used
to e
stab
lish
a “l
oyal
ty”
patt
ern
to a
PP
S (b
ased
on
all t
heir
prov
ider
mem
bers
) whe
re m
ost o
f the
m
embe
r’s se
rvic
es a
re re
nder
ed.
Whe
n th
ere
is on
ly o
ne P
erfo
rmin
g Pr
ovid
er S
yste
m (P
PS) i
n a
defin
ed
geog
raph
ic a
rea/
geop
oliti
cal a
rea,
the
entir
e m
atch
ed M
edic
aid
bene
ficia
ry
popu
latio
n w
ill b
e th
e as
signe
d po
pula
tion
in th
at g
eogr
aphi
c/ge
opol
itica
l ar
ea.
DSRI
P AT
TRIB
UTI
ON
: SO
LE P
PS IN
GEO
GRA
PHIC
AL
REG
ION
60
DSRI
P AT
TRIB
UTI
ON
: MU
LTIP
LE P
PS IN
G
EOG
RAPH
ICAL
REG
ION
W
hen
ther
e is
mor
e th
an o
ne P
erfo
rmin
g Pr
ovid
er S
yste
m in
a d
efin
ed g
eogr
aphi
c/ge
opol
itica
l ar
ea, t
he fo
llow
ing
met
hodo
logy
will
be
utili
zed*
:
1.M
atch
ing
Goa
l - A
ssig
nmen
t to
a PP
S ba
sed
on th
e re
cipi
ent’s
cur
rent
util
izatio
n pa
tter
ns,
incl
udin
g pl
ural
ity o
f visi
ts. B
enef
icia
ries w
ho re
ceiv
e pl
ural
ity o
f the
ir qu
alify
ing
serv
ices
from
pr
ovid
ers t
hat a
re n
ot p
artic
ipat
ing
in a
ny D
SRIP
Per
form
ing
Prov
ider
Sys
tem
will
be
excl
uded
fr
om a
ttrib
utio
n.
2.Se
rvic
e G
roup
ings
- To
mee
t thi
s goa
l, th
e m
etho
dolo
gy w
ill a
ggre
gate
pat
ient
ser
vice
vol
ume
acro
ss fo
ur d
iffer
ent g
roup
s of s
ervi
ces a
nd a
ssig
n at
trib
utio
n us
ing
a hi
erar
chic
al se
rvic
e pr
iorit
y as
follo
ws:
1st
prio
rity
- car
e m
anag
emen
t pro
vide
r;
2nd
prio
rity
- out
patie
nt (p
hysic
al a
nd b
ehav
iora
l hea
lth) i
nclu
ding
Prim
ary
Care
Pro
vide
rs
and
othe
r pra
ctiti
oner
s;
3rd
prio
rity
- em
erge
ncy
room
; and
4th
prio
rity
- inp
atie
nt.
* A
met
hodo
logy
for i
nclu
ding
long
term
car
e se
rvic
es a
nd su
ppor
ts w
ill n
eed
to b
e de
velo
ped.
Prio
rity
may
als
o be
mod
ified
ba
sed
on P
CP a
ssig
nmen
t and
util
izat
ion.
61
3.At
trib
utio
n M
etho
d –
Onc
e th
e PP
S ne
twor
k of
serv
ice
prov
ider
s is f
inal
ized
that
ove
rall
PPS’
se
rvic
e ne
twor
k w
ill b
e lo
aded
into
the
attr
ibut
ion
syst
em fo
r rec
ipie
nt lo
yalty
to b
e as
signe
d ba
sed
on to
tal v
isit c
ount
s to
the
over
all P
PS n
etw
ork
in e
ach
of th
e hi
erar
chic
al se
rvic
e ca
tego
ries (
men
tione
d in
the
last
side
).
4.At
trib
utio
n Ad
just
men
ts/M
CO In
put -
Adj
ustm
ents
to a
ttrib
utio
n ba
sed
on k
now
n va
riabl
es
(e.g
, rec
ent c
hang
es to
the
reci
pien
t’s a
ddre
ss, P
CP a
ssig
nmen
t, re
cent
cha
nges
in a
cces
s pa
tter
ns) m
ay b
e m
ade
by th
e st
ate
with
MCO
inpu
t if d
eem
ed a
ppro
pria
te b
y da
ta.
A m
etho
dolo
gy is
also
em
ploy
ed to
ass
ign
unm
atch
ed m
embe
rs.
At th
e en
d of
eac
h m
easu
rem
ent y
ear a
djus
tmen
ts m
ay b
e m
ade
for t
he p
urpo
se o
f den
omin
ator
dev
elop
men
t.
5.Fi
nal A
ttrib
utio
n As
sign
men
t - A
fter
all
visit
s aga
inst
all
prov
ider
s are
talli
ed u
p fo
r a g
iven
se
rvic
e ty
pe a
nd a
ppro
pria
te a
djus
tmen
ts m
ade,
the
met
hodo
logy
ass
igns
the
mem
ber t
o a
singl
e PP
S.
6.At
trib
utio
n Fo
r Mea
sure
men
t – A
t the
end
of e
ach
mea
sure
men
t per
iod,
att
ribut
ion
will
be
adju
sted
to a
ccou
nt fo
r con
tinuo
us e
nrol
lmen
t crit
eria
and
any
oth
er a
djus
tmen
ts n
eces
sary
to
assu
re a
pro
per m
easu
rem
ent d
enom
inat
or.
* M
ore
info
rmat
ion
to fo
llow
62
DSRI
P AT
TRIB
UTI
ON
: MU
LTIP
LE P
PS IN
GEO
GRA
PHIC
AL R
EGIO
N
DS
RIP
PRO
JECT
VAL
UATI
ON
The
max
imum
DSR
IP p
roje
ct a
nd a
pplic
atio
n va
luat
ion
will
follo
w a
five
-ste
p pr
oces
s.
STEP
1: P
ROJE
CT IN
DEX
SCO
RE
oEa
ch p
roje
ct in
the
DSRI
P St
rate
gy M
enu
(Att
achm
ent J
) is g
iven
a P
roje
ct
Inde
x Sc
ore
whi
ch is
a ra
tio o
ut o
f a to
tal o
f 60
poss
ible
poi
nts o
f eac
h pr
ojec
t (X/
60 =
pro
ject
inde
x sc
ore)
.
oPr
ojec
t Ind
ex S
core
s are
bas
ed u
pon
a gr
adin
g ru
bric
that
eva
luat
ed th
e pr
ojec
t’s a
bilit
y to
tran
sfor
m th
e he
alth
car
e sy
stem
. The
Sta
te h
as a
ssig
ned
an in
dex
scor
e to
eac
h pr
ojec
t bas
ed o
n th
e gr
adin
g ru
bric
.
Fi
ve e
lem
ents
(T
otal
: 60p
t max
per
pro
ject
) 1)
Pote
ntia
l for
ach
ievi
ng sy
stem
tr
ansf
orm
atio
n……
……
…...
30pt
s
2)Po
tent
ial f
or re
duci
ng p
reve
ntab
le
even
t……
……
……
……
……
……
10pt
s
3)Ca
paci
ty fo
r Pro
ject
to a
ffect
M
edic
aid
bene
ficia
ries…
..10p
ts
4)
Pote
ntia
l Cos
t Sav
ings
to
Med
icai
d……
……
……
……
……
5pts
5)Ro
bust
ness
of E
vide
nce
Base
d su
gges
tion…
……
……
……
…5p
ts
Step
1a:
Inde
x Sc
ore
(IS)
• Pr
ojec
ts a
re e
valu
ated
acr
oss 5
el
emen
ts a
nd g
iven
an
inde
x sc
ore.
•I
ndiv
idua
l pro
ject
inde
x sc
ores
ar
e se
t by
DOH
and
are
rele
ased
pr
ior t
o th
e ap
plic
atio
n pe
riod
Step
1b:
Con
vert
Inde
x Sc
ore
into
a
Proj
ect
Inde
x Sc
ore
The
IS is
then
div
ided
by
the
max
imum
inde
x sc
ore
(MIS
) to
get
the
Proj
ect I
ndex
Sco
re (P
IS)
[IS] /
[MIS
] = P
IS
64
STEP
2: P
ROJE
CT P
MPM
oTh
e se
cond
step
cre
ates
a p
roje
ct P
MPM
(per
mem
ber p
er m
onth
) by
mul
tiply
ing
the
proj
ect i
ndex
scor
e by
the
stat
e’s v
alua
tion
benc
hmar
k.
Th
e va
luat
ion
benc
hmar
k is
pre-
set b
y th
e st
ate
and
varie
s bas
ed u
pon
the
num
ber o
f pro
ject
s pr
opos
ed b
y an
app
lican
t.
oSi
nce
addi
tiona
l pro
ject
s will
shar
e in
fras
truc
ture
and
reso
urce
s, t
he
valu
atio
n be
nchm
ark
is di
scou
nted
as a
pplic
ants
sele
ct a
dditi
onal
pro
ject
s.
oAl
thou
gh th
e pr
ojec
t PM
PM le
vels
drop
with
the
incl
usio
n of
add
ition
al
proj
ects
, the
ove
rall
Perf
orm
ing
Proj
ect S
yste
m v
alua
tion
will
gen
eral
ly
incr
ease
as m
ore
proj
ects
are
add
ed to
the
over
all P
PS e
ffort
.
Proj
ect P
MPM
Step
2a:
Val
uatio
n Be
nchm
ark
Valu
atio
n be
nchm
ark
will
be
an
assig
ned
valu
e, d
eriv
ed fr
om si
mila
r de
liver
y re
form
s, e
xpre
ssed
in a
PM
PM fo
rmat
and
will
be
prov
ided
by
DO
H ba
sed
upon
the
num
ber o
f pr
ojec
t an
appl
ican
t sel
ects
.
Step
2b:
Pro
ject
PM
PM
[pro
ject
inde
x sc
ore]
x
[val
uatio
n be
nchm
ark]
=
Proj
ect P
MPM
STEP
3: P
LAN
APP
LICA
TIO
N S
CORE
oTh
e th
ird st
ep d
eter
min
es th
e pl
an a
pplic
atio
n sc
ore
base
d on
a
tota
l of 1
00 p
oint
s pos
sible
for e
ach
appl
icat
ion
(X/1
00 =
App
licat
ion
Scor
e).
oSc
ore
will
driv
e th
e pe
rcen
t of t
he m
axim
um p
roje
ct v
alua
tion
for
each
pro
ject
. o
Scor
e ba
sed
on th
e fid
elity
to th
e pr
ojec
t des
crip
tion,
and
like
lihoo
d of
ach
ievi
ng im
prov
emen
t by
usin
g th
at p
roje
ct.
o
The
stat
e is
deve
lopi
ng a
gra
ding
syst
em fo
r the
pla
n ap
plic
atio
n sc
ore
in c
olla
bora
tion
with
CM
S. T
his g
radi
ng sy
stem
will
ens
ure
non-
dupl
icat
ion
of p
roje
cts/
effo
rts w
ithin
a p
roje
ct p
lan.
o
Appl
icat
ions
are
scor
ed b
y in
depe
nden
t ass
esso
r and
mak
es
reco
mm
enda
tions
.
66
STEP
3: P
LAN
APP
LICA
TIO
N S
CORE
oPe
rfor
min
g pr
ovid
er sy
stem
s are
enc
oura
ged
to p
artn
er w
ith p
rovi
ders
pa
rtic
ipat
ing
in th
e IA
AF p
rogr
am a
s par
t of t
heir
DSRI
P pe
rfor
man
ce
netw
ork.
The
pla
n ap
plic
atio
n sc
ore
rubr
ic d
evel
oped
by
stat
e in
co
llabo
ratio
n w
ith C
MS
may
incl
ude
bonu
s poi
nts f
or a
ddre
ssin
g su
stai
nabi
lity
issue
s in
com
mun
ities
serv
ed b
y IA
AF p
rovi
ders
.
oAp
plic
atio
ns w
ill a
lso b
e sc
ored
bas
ed o
n an
app
lican
t’s c
omm
itmen
t to
deve
lopi
ng a
cap
abili
ty to
resp
onsib
ly re
ceiv
e ris
k-ba
sed
paym
ents
from
m
anag
ed c
are
plan
s thr
ough
the
DSRI
P pr
ojec
t per
iod.
67
STEP
4: M
AXIM
UM
PRO
JECT
VAL
UE
In th
e fo
urth
step
, the
Max
imum
Pro
ject
Val
ue is
cal
cula
ted
by m
ultip
lyin
g:
th
e pr
ojec
t PM
PM,
th
e pr
ojec
t pla
n ap
plic
atio
n sc
ore,
the
num
ber o
f Med
icai
d be
nefic
iarie
s att
ribut
ed to
the
proj
ect,
and
the
dura
tion
of th
e DS
RIP
proj
ect.
Max
imum
Pro
ject
Val
ue =
[Pro
ject
PM
PM] x
[# o
f Med
icai
d Be
nefic
iarie
s] x
[Pla
n Ap
plic
atio
n Sc
ore]
x [D
SRIP
Pro
ject
Dur
atio
n]
Max
imum
Pro
ject
Va
luat
ion
Not
es
Not
e on
Mem
ber A
ttrib
utio
n:
Appl
ican
ts w
ill p
rovi
de a
n at
trib
utio
n as
sess
men
t in
thei
r su
bmiss
ion
(to b
e ve
rifie
d by
the
asse
ssor
) ide
ntify
ing
the
num
ber
of M
edic
aid
ben
efic
iarie
s th
at a
re
inte
nded
to b
enef
it fr
om th
eir
proj
ect.
Not
e on
Pro
ject
Dur
atio
n:
The
DSRI
P Pr
ogra
m D
urat
ion
is se
t to
be
60 m
onth
s. T
he a
pplic
atio
n va
luat
ion
will
ass
ume
that
pr
ovid
ers
are
to p
artic
ipat
e in
the
prog
ram
for t
he e
ntire
tim
e.
Max
imum
Pro
ject
Val
ue =
[App
licat
ion
PMPM
] x
[P
roje
ct P
lan
Appl
icat
ion
Scor
e] x
[#
of M
edic
aid
bene
ficia
ries]
x
[Dur
atio
n of
DSR
IP P
rogr
am]
STEP
5: M
AXIM
UM
APP
LICA
TIO
N V
ALU
E
oO
nce
the
max
imum
pro
ject
val
ues h
ave
been
det
erm
ined
, th
e m
axim
um a
pplic
atio
n va
lue
for a
Per
form
ing
Prov
ider
Sy
stem
is c
alcu
late
d by
add
ing
toge
ther
eac
h of
the
max
imum
pro
ject
val
ues f
or a
giv
en P
erfo
rmin
g Pr
ovid
er
Syst
em’s
appl
icat
ion.
69
STEP
5: M
AXIM
UM
APP
LICA
TIO
N V
ALU
E
oTh
e m
axim
um a
pplic
atio
n va
lue
repr
esen
ts th
e hi
ghes
t po
ssib
le fi
nanc
ial a
lloca
tion
a Pe
rfor
min
g Pr
ovid
er S
yste
m
can
rece
ive
for t
heir
proj
ect p
lan
over
the
dura
tion
of th
eir
part
icip
atio
n in
the
DSRI
P pr
ogra
m.
oPe
rfor
min
g Pr
ovid
er S
yste
ms
may
rece
ive
less
than
thei
r m
axim
um a
lloca
tion
if th
ey d
o no
t mee
t met
rics a
nd/o
r if
DSRI
P fu
ndin
g is
redu
ced
beca
use
of th
e st
atew
ide
pena
lty).
70
DS
RIP
PRO
JECT
VAL
UATI
ON
SCE
NAR
IO:
ILLU
STRA
TIVE
EXA
MPL
E
DSRI
P SC
ENAR
IO: H
PI*
PRO
JECT
VAL
UATI
ON
ST
EP 1
: PRO
JECT
INDE
X SC
ORE
S HP
I Pro
ject
Pla
n (c
onta
inin
g 6
proj
ects
) Pr
ojec
t Ind
ex
Scor
es
Proj
ect 1
: 2.a
.i Cr
eate
Inte
grat
ed D
eliv
ery
Syst
ems
that
are
focu
sed
on E
BM/P
HM to
re
duce
avo
idab
le h
ospi
taliz
atio
ns
0.9
3
Proj
ect 2
: 2.a
.ii In
crea
se c
ertif
icat
ion
of p
rimar
y ca
re p
ract
ition
ers
with
PCM
H
cert
ifica
tion
to re
duce
avo
idab
le h
ospi
taliz
atio
ns
0.6
2
Proj
ect 3
: 2.
b.vi
i Im
plem
entin
g th
e IN
TERA
CT p
roje
ct (i
npat
ient
tran
sfer
avo
idan
ce
prog
ram
for S
kille
d N
ursi
ng F
acili
ty)
0.68
Proj
ect 4
: 3.a
.i In
tegr
atio
n of
prim
ary
care
and
beh
avio
ral h
ealth
se
rvic
es(B
ehav
iora
l Hea
lth)
0.65
Proj
ect 5
: 3.c
.i Ev
iden
ced
base
d st
rate
gies
for d
isea
se m
anag
emen
t in
high
risk
po
pula
tions
(Car
diov
ascu
lar H
ealth
) 0.
48
Proj
ect 6
: Dom
ain
4 Fo
cus
Area
B. R
educ
e ill
ness
, dis
abili
ty a
nd d
eath
rela
ted
to
toba
cco
use
and
seco
ndha
nd s
mok
e ex
posu
re
0.38
72
* HP
I is “
Heal
th P
artn
ers I
nitia
tive”
- a
fictit
ious
per
form
ing
prov
ider
syst
em –
for i
llust
ratio
n pu
rpos
es.
DSRI
P SC
ENAR
IO: P
ROJE
CT V
ALUA
TIO
N
VALU
ATIO
N B
ENCH
MAR
K TA
BLE
Num
ber o
f pro
ject
s Va
luat
ion
Benc
hmar
k PM
PMs*
5
(min
imum
allo
wed
) $
8.00
6
$7.
20
7 $
6.80
8
$6.
65
9 $
6.50
10
(max
imum
allo
wed
) $
6.50
Belo
w is
the
curr
ent s
tate
val
uatio
n be
nchm
ark
tabl
e w
ith a
ben
chm
ark
base
line
of $
8.
73
* PM
PMs d
rop
as m
ore
proj
ects
are
add
ed to
acc
ount
for t
he a
bilit
y to
leve
rage
sha
red
capa
citie
s (e
.g.,
adm
inist
ratio
n, IT
syst
ems e
tc).
DSRI
P SC
ENAR
IO: H
PI P
ROJE
CT V
ALUA
TIO
N
STEP
2: P
ROJE
CT P
MPM
HP
I Pro
ject
Pla
n (c
onta
inin
g 6
proj
ects
) Pr
ojec
t Ind
ex S
core
s Va
luat
ion
Benc
hmar
k
(5 P
roje
ct B
ase
Valu
e =$
8)
Proj
ect P
MPM
Proj
ect 1
: 2.a
.i Cr
eate
Inte
grat
ed D
eliv
ery
Syst
ems t
hat a
re fo
cuse
d on
EBM
/PHM
to re
duce
av
oida
ble
hosp
italiz
atio
ns
0.9
3 $7
.20
$6.7
0
Proj
ect 2
: 2.a
.ii In
crea
se ce
rtifi
catio
n of
prim
ary
care
pra
ctiti
oner
s with
PCM
H ce
rtifi
catio
n to
re
duce
avo
idab
le h
ospi
taliz
atio
ns
0.6
2 $7
.20
$4.4
6
Proj
ect 3
: 2.
b.vi
i Im
plem
entin
g th
e IN
TERA
CT
proj
ect (
inpa
tient
tran
sfer
avo
idan
ce p
rogr
am fo
r Sk
illed
Nur
sing
Fac
ility
) 0.
68
$7.2
0 $4
.90
Proj
ect 4
: 3.a
.i In
tegr
atio
n of
prim
ary
care
and
be
havi
oral
hea
lth se
rvic
es(B
ehav
iora
l Hea
lth)
0.65
$7
.20
$4.6
8
Proj
ect 5
: 3.c
.i Ev
iden
ced
base
d st
rate
gies
for
dise
ase
man
agem
ent i
n hi
gh ri
sk p
opul
atio
ns
(Car
diov
ascu
lar H
ealth
) 0.
48
$7.2
0 $3
.46
Proj
ect 6
: Dom
ain
4 Fo
cus A
rea
B. R
educ
e ill
ness
, dis
abili
ty a
nd d
eath
rela
ted
to to
bacc
o us
e an
d se
cond
hand
smok
e ex
posu
re
0.38
$7
.20
$2.7
4
74
HPI
Pro
ject
Pla
n (C
onta
inin
g 6
proj
ects
) Pr
ojec
t PM
PM
Proj
ect P
lan
Appl
icat
ion
Scor
e
# of
Att
ribut
ed
Med
icai
d M
embe
rs
# of
DSR
IP M
onth
s M
axim
um P
roje
ct
Valu
atio
n
Proj
ect 1
: 2.a
.i Cr
eate
Inte
grat
ed
Del
iver
y Sy
stem
s th
at a
re fo
cuse
d on
EBM
/PH
M to
redu
ce a
void
able
ho
spita
lizat
ions
$6.7
0 .8
5 10
,000
60
$3
,417
,000
Proj
ect 2
: 2.a
.ii In
crea
se
cert
ifica
tion
of p
rimar
y ca
re
prac
titio
ners
with
PCM
H
cert
ifica
tion
to re
duce
avo
idab
le
hosp
italiz
atio
ns
$4.4
6 .8
5 10
,000
60
$2
,274
,600
Proj
ect 3
: 2.
b.vi
i Im
plem
entin
g th
e IN
TERA
CT p
roje
ct (i
npat
ient
tr
ansf
er a
void
ance
pro
gram
for
Skill
ed N
ursi
ng F
acili
ty)
$4.9
0 .8
5 10
,000
60
$2,4
99,0
00
Proj
ect 4
: 3.a
.i In
tegr
atio
n of
pr
imar
y ca
re a
nd b
ehav
iora
l hea
lth
serv
ices
(Beh
avio
ral H
ealth
) $4
.68
.85
10,0
00
60
$2
,386
,800
Proj
ect 5
: 3.c
.i Ev
iden
ced
base
d st
rate
gies
for d
isea
se m
anag
emen
t in
hig
h ris
k po
pula
tions
(C
ardi
ovas
cula
r Hea
lth)
$3.4
6 .8
5 10
,000
60
$1,7
64,6
00
Proj
ect 6
: Dom
ain
4 Fo
cus A
rea
B.
Redu
ce il
lnes
s, d
isab
ility
and
dea
th
rela
ted
to to
bacc
o us
e an
d se
cond
hand
smok
e ex
posu
re
$2.7
4 .8
5 10
,000
60
$1,3
97,4
00
DSRI
P SC
ENAR
IO: H
PI P
ROJE
CT V
ALUA
TIO
N
STEP
3: P
ROJE
CT P
LAN
APP
LICA
TIO
N S
CORE
ST
EP 4
: MAX
IMU
M P
ROJE
CT V
ALUA
TIO
N
75
DSRI
P SC
ENAR
IO: H
PI P
ROJE
CT V
ALUA
TIO
N
STEP
5: M
AXIM
UM
APP
LICA
TIO
N V
ALU
E
HPI
Pro
ject
Pla
n (C
onta
inin
g 6
proj
ects
) M
axim
um P
roje
ct
Valu
atio
n Pr
ojec
t 1: 2
.a.i
Crea
te In
tegr
ated
D
eliv
ery
Syst
ems
that
are
focu
sed
on E
BM/P
HM
to re
duce
avo
idab
le
hosp
italiz
atio
ns
$3,4
17,0
00
Proj
ect 2
: 2.a
.ii In
crea
se
cert
ifica
tion
of p
rimar
y ca
re
prac
titio
ners
with
PCM
H
cert
ifica
tion
to re
duce
avo
idab
le
hosp
italiz
atio
ns
$2,2
74,6
00
Proj
ect 3
: 2.
b.vi
i Im
plem
entin
g th
e IN
TERA
CT p
roje
ct (i
npat
ient
tr
ansf
er a
void
ance
pro
gram
for
Skill
ed N
ursi
ng F
acili
ty)
$2,4
99,0
00
Proj
ect 4
: 3.a
.i In
tegr
atio
n of
pr
imar
y ca
re a
nd b
ehav
iora
l hea
lth
serv
ices
(Beh
avio
ral H
ealth
) $2
,386
,800
Proj
ect 5
: 3.c
.i Ev
iden
ced
base
d st
rate
gies
for d
isea
se m
anag
emen
t in
hig
h ris
k po
pula
tions
(C
ardi
ovas
cula
r Hea
lth)
$1,7
64,6
00
Proj
ect 6
: Dom
ain
4 Fo
cus A
rea
B.
Redu
ce il
lnes
s, d
isab
ility
and
dea
th
rela
ted
to to
bacc
o us
e an
d se
cond
hand
smok
e ex
posu
re
$1,3
97,4
00
Max
imum
App
licat
ion
Valu
e $1
3,73
9,40
0*
*The
max
imum
app
licat
ion
valu
e re
pres
ents
the
high
est p
ossib
le
finan
cial
allo
catio
n a
Perf
orm
ing
Prov
ider
Sys
tem
can
rece
ive
for t
heir
proj
ect p
lan
over
the
dura
tion
of th
eir
part
icip
atio
n in
the
DSRI
P pr
ogra
m.
Perfo
rmin
g Pr
ovid
er S
yste
ms m
ay
rece
ive
less
than
thei
r max
imum
al
loca
tion
if th
ey d
o no
t mee
t met
rics
and/
or if
DSR
IP fu
ndin
g is
redu
ced
beca
use
of th
e st
atew
ide
pena
lty).
76
DS
RIP
PERF
ORM
ANCE
ASS
ESSM
ENT
All D
SRIP
Pay
men
ts L
inke
d to
Per
form
ance
DSRI
P FI
NAN
CE F
RAM
EWO
RK
Proc
ess
Met
rics
Out
com
e M
etric
s &
Avoi
dabl
e H
ospi
taliz
atio
ns
$
Tim
e
Popu
latio
n H
ealth
Mea
sure
s
78
oDS
RIP
paym
ents
for e
ach
prov
ider
are
con
tinge
nt o
n th
em m
eetin
g pr
ogra
m a
nd
proj
ect m
etric
s and
mile
ston
es d
efin
ed in
the
DSRI
P Pl
an a
nd c
onsis
tent
with
the
valu
atio
n pr
oces
s.
o
Base
d up
on a
pro
ject
’s va
luat
ion,
ince
ntiv
e pa
ymen
t val
ues w
ill b
e ca
lcul
ated
for e
ach
met
ric/m
ilest
one
dom
ain
in th
e DS
RIP
proj
ect p
lan
by m
ultip
lyin
g th
e to
tal v
alua
tion
of
the
proj
ect i
n a
give
n ye
ar b
y th
e m
ilest
one
perc
enta
ges s
peci
fied
belo
w.
M
etric
/Mile
ston
e Do
mai
ns
Perf
orm
ance
Pa
ymen
t*
Year
1
(CY
15)
Year
2
(CY
16)
Year
3
(CY
17)
Year
4
(CY
18)
Year
5
(CY
19)
Proj
ect p
rogr
ess m
ilest
ones
(D
omai
n 1)
P4
R/ P
4P
80%
60
%
40%
20
%
0%
Syst
em T
rans
form
atio
n an
d Fi
nanc
ial S
tabi
lity
Mile
ston
es
(Dom
ain
2)
P4P
0%
0%
20%
35
%
50%
P4R
10%
10
%
5%
5%
5%
Clin
ical
Impr
ovem
ent M
ilest
ones
(D
omai
n 3)
P4P
0%
15%
25
%
30%
35
%
P4R
5%
10%
5%
5%
5%
Popu
latio
n he
alth
Out
com
e M
ilest
ones
(Dom
ain
4)
P4R
5%
5%
5%
5%
5%
DSRI
P FU
NDI
NG
DIS
TRIB
UTI
ON
STA
GES
79
P4R
= Pa
y fo
r Rep
ortin
g
P4P
= Pa
y fo
r Per
form
ance
DSRI
P PE
RFO
RMAN
CE M
ILES
TON
ES –
PAY
FO
R PE
RFO
RMAN
CE
oAn
nual
impr
ovem
ent t
arge
ts w
ith u
se a
met
hodo
logy
of r
educ
ing
the
gap
to th
e go
al b
y 10
%.
oFo
r exa
mpl
e, if
the
base
line
data
for a
mea
sure
is 5
2 pe
rcen
t and
the
goal
is
90 p
erce
nt, t
he g
ap to
the
goal
is 3
8. T
he ta
rget
for t
he p
roje
ct’s
first
ye
ar o
f per
form
ance
wou
ld b
e 3.
8 pe
rcen
t inc
reas
e in
the
resu
lt (ta
rget
55
.8 p
erce
nt).
oEa
ch su
bseq
uent
yea
r wou
ld c
ontin
ue to
be
set w
ith a
targ
et u
sing
the
mos
t rec
ent y
ear’s
dat
a. T
his w
ill a
ccou
nt fo
r sm
alle
r gai
ns in
subs
eque
nt
year
s as p
erfo
rman
ce im
prov
es to
war
d th
e go
al o
r mea
sure
men
t cei
ling.
oPe
rfor
min
g Pr
ovid
er S
yste
ms m
ay re
ceiv
e le
ss th
an th
eir m
axim
um
allo
catio
n if
they
do
not m
eet m
etric
s and
/or i
f DSR
IP fu
ndin
g is
redu
ced
beca
use
of th
e st
atew
ide
pena
lty).
80
DSRI
P HI
GH
PERF
ORM
ANCE
FU
ND
Who
is e
ligib
le?
PPS,
dur
ing
a gi
ven
perf
orm
ance
per
iod,
that
exc
eed
thei
r m
etric
s & a
chie
ve h
igh
perf
orm
ance
by:
Ex
ceed
ing
a pr
eset
hig
her b
ench
mar
k fo
r red
ucin
g av
oida
ble
hosp
italiz
atio
ns (e
x. 2
0 pe
rcen
t gap
to g
oal o
r the
90t
h pe
rcen
tile
of th
e st
atew
ide
perf
orm
ance
); or
M
eetin
g ce
rtai
n hi
gher
per
form
ance
targ
ets f
or th
eir a
ssig
ned
beha
vior
al h
ealth
pop
ulat
ion
will
be
elig
ible
for a
dditi
onal
DSR
IP
fund
s fro
m th
e hi
gh p
erfo
rman
ce fu
nd.
81
DSRI
P HI
GH
PERF
ORM
ANCE
FU
ND
Who
dec
ides
whe
re to
set t
he h
igh
perf
orm
ance
be
nchm
arks
? o
The
stat
e’s Q
ualit
y an
d M
easu
res C
omm
ittee
(QM
C) w
ill b
e re
spon
sible
for s
ettin
g th
e hi
gh p
erfo
rman
ce ta
rget
goa
ls in
clud
ing
the
beha
vior
al h
ealth
hig
h pe
rfor
man
ce a
void
able
hos
pita
lizat
ion
thre
shol
d fo
r bon
us p
aym
ent p
urpo
ses.
oTh
e Q
MC
incl
udes
repr
esen
tativ
es fr
om v
ario
us se
ctor
s of h
ealth
care
in
clud
ing
hosp
itals,
beh
avio
ral h
ealth
pro
vide
rs, n
ursin
g ho
mes
, m
anag
ed c
are
plan
s, p
rovi
der o
rgan
izatio
ns a
nd c
onsu
mer
re
pres
enta
tion.
82
DSRI
P HI
GH
PERF
ORM
ANCE
FU
ND
How
is th
e Hi
gh P
erfo
rman
ce F
und
finan
ced?
oFo
r Yea
rs 2
-5, u
p to
10
perc
ent o
f the
tota
l DSR
IP fu
nds f
rom
th
e Pu
blic
Hos
pita
l Tra
nsfo
rmat
ion
Fund
and
Saf
ety
Net
Pe
rfor
man
ce P
rovi
der S
yste
m T
rans
form
atio
n Fu
nd w
ill b
e se
t asid
e to
rew
ard
high
per
form
ing
syst
ems.
oIn
add
ition
, oth
erw
ise u
nrew
arde
d fu
nds w
ill a
lso b
e re
dire
cted
to th
e hi
gh p
erfo
rman
ce fu
nd.
83
ST
ATEW
IDE
ACCO
UN
TABI
LITY
We
Are
All I
n Th
is To
geth
er!
oBe
ginn
ing
in Y
ear 3
, lim
its o
n fu
ndin
g av
aila
ble
and
prov
ider
in
cent
ive
paym
ents
may
be
subj
ect t
o re
duct
ions
bas
ed o
n st
atew
ide
perf
orm
ance
.
oSt
atew
ide
perf
orm
ance
will
be
asse
ssed
on
a pa
ss o
r fai
l bas
is fo
r a
set o
f fou
r mile
ston
es.
oTh
e st
ate
mus
t pas
s all
four
mile
ston
es to
avo
id D
SRIP
redu
ctio
ns.
oIf
pena
lties
are
app
lied,
CM
S re
quire
s the
stat
e to
redu
ce fu
nds i
n an
equ
al d
istrib
utio
n, a
cros
s all
DSRI
P pr
ojec
ts.
oTh
e DS
RIP
high
per
form
ance
fund
will
not
be
affe
cted
by
any
pena
lties
.
85
STAT
EWID
E PE
RFO
RMAN
CE A
ND
ACCO
UN
TABI
LITY
1)St
atew
ide
perf
orm
ance
on
a un
iver
sal s
et o
f del
iver
y sy
stem
im
prov
emen
t met
rics a
s def
ined
in A
ttac
hmen
t J.
2)Co
mpo
site
mea
sure
of s
ucce
ss o
f pro
ject
s sta
tew
ide
on p
roje
ct sp
ecifi
c an
d po
pula
tion-
wid
e qu
ality
met
rics.
3)G
row
th in
stat
ewid
e to
tal M
edic
aid
spen
ding
, inc
ludi
ng M
RT sp
endi
ng,
that
is a
t or b
elow
the
targ
et tr
end
rate
, and
gro
wth
in st
atew
ide
tota
l in
patie
nt a
nd e
mer
genc
y ro
om sp
endi
ng a
t or b
elow
the
targ
et tr
end
rate
.
4)Im
plem
enta
tion
of th
e st
ate’
s man
aged
car
e co
ntra
ctin
g pl
an a
nd
mov
emen
t tow
ard
a go
al o
f 90
perc
ent o
f man
aged
car
e pa
ymen
ts to
pr
ovid
ers
usin
g va
lue-
base
d pa
ymen
t met
hodo
logi
es.
STAT
EWID
E PE
RFO
RMAN
CE: M
ILES
TON
ES
86
DS
RIP
RESO
URC
ES
DSRI
P IN
FORM
ATIC
S PR
ODU
CTS
oDa
ta w
orkb
ooks
on
Med
icai
d vo
lum
e (c
laim
s/en
coun
ters
, di
scha
rges
and
mem
ber c
ount
s by
prov
ider
/reg
ion/
coun
ty (n
on-
PHI)
deve
lope
d by
Sal
ient
ava
ilabl
e on
the
DSRI
P w
ebsit
e.
oW
eb B
ased
Per
form
ance
Das
hboa
rds w
ith d
rilla
ble
data
on
mem
ber c
ount
s by
regi
on a
nd b
asel
ine
perf
orm
ance
dat
a (P
QIs
, PP
Rs, e
tc.)
are
unde
r dev
elop
men
t by
Salie
nt a
nd w
ill b
e av
aila
ble
on D
SRIP
web
site
(pla
nned
for J
une)
.
oDS
RIP
Perf
orm
ance
Por
tal (
expe
cted
ear
ly fa
ll) w
ill h
ave
expa
nded
ca
pabi
litie
s for
dee
per d
ive
anal
ytic
s for
DSR
IP p
roje
cts.
oRe
port
subm
issio
n ca
pabi
litie
s are
also
bei
ng b
uilt
into
the
expa
nded
Hea
lth H
ome
Port
al.
88
SALI
ENT
DATA
WO
RKBO
OKS
89
DSR
IP M
ETRI
C W
ORK
BOO
KS
Prog
ram
-->
Mos
t Rec
ent
NYS
MM
C 20
12 (
or
2011
*)
Nat
iona
l N
CQA
Med
icai
d M
ean
Nat
iona
l N
CQA
Med
icai
d 90
th
Perc
entil
e
Nat
iona
l N
CQA
Med
icai
d 10
th
Perc
entil
e
Com
men
ts
Met
ric
Met
ric S
ourc
e EB
M C
hron
ic D
iseas
e CC
& T
x Ca
re
M
etric
-- A
void
able
Eve
nts
6.79
*
Per 1
00 A
t Ria
k Ad
miss
ions
PP
R Pe
r 100
3M
x
x
59.5
7*
Pe
r 100
Elig
ible
ER
Visit
s PP
V (E
D)
3M
x x
11.2
3*
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
1 (D
M S
hort
-ter
m c
omp.
) AH
RQ
x x
NA
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
2 (P
erfo
rate
d Ap
pend
ix)
AHRQ
16.4
2*
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
3 (D
M lo
ng te
rm c
omp.
) AH
RQ
x
81.2
4*
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
5 (C
OPD
) AH
RQ
x x
11.0
4*
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
7 (H
TN)
AHRQ
x
x
30.7
2*
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
8 (C
ong.
Hea
rt F
ailu
re)
AHRQ
x
x
NA
Pe
r 100
,000
M
embe
r Mon
ths
PQI#
9 (L
ow b
irth
wei
ght)
AH
RQ
90
DSRI
P O
NLI
NE
VALU
ATIO
N T
OO
L
91
http
://w
ww
.hea
lth.n
y.go
v/he
alth
_car
e/m
edic
aid/
rede
sign
/del
iver
y_sy
stem
_ref
orm
_inc
entiv
e_pa
ymen
t_pr
ogra
m.h
tm
oLi
nks t
o M
RT W
aive
r Am
endm
ent
Docu
men
ts (S
TCs)
o
DSRI
P G
loss
ary
oDS
RIP
Publ
ic M
eetin
g Da
tes &
Loc
atio
ns
oDS
RIP
Pres
enta
tion
oDS
RIP
Tool
kit
oDS
RIP
Valu
atio
n To
ol
oLi
nks t
o Pe
rfor
man
ce D
ata
oDS
RIP
emai
l add
ress
o
DSRI
P FA
Qs…
.mor
e to
follo
w!
DSRI
P W
EBSI
TE
92
IN
DEPE
NDE
NT
ASSE
SSO
R AN
D EV
ALUA
TOR
Ke
y DS
RIP
Cont
ract
ors
INDE
PEN
DEN
T AS
SESS
OR
The
stat
e w
ill c
ontr
act w
ith a
n in
depe
nden
t ent
ity w
ith e
xper
tise
in
deliv
ery
syst
em re
stru
ctur
ing
and
impr
ovem
ent,
proj
ect m
anag
emen
t, pa
ymen
t ref
orm
and
with
exp
erie
nce
in im
plem
enta
tion
of st
atew
ide
prog
ram
s.
•In
depe
nden
t ass
esso
r will
:
Co
nduc
t a tr
ansp
aren
t and
impa
rtia
l rev
iew
of a
ll p
ropo
sed
DSRI
P pr
ojec
t pla
ns;
M
ake
proj
ect a
ppro
val r
ecom
men
datio
ns to
the
stat
e;
Co
nduc
t a m
id-p
oint
ass
essm
ent o
f Pro
ject
Pla
ns;
M
anag
e Le
arni
ng C
olla
bora
tives
thro
ugho
ut th
e st
ate;
and
Ove
rsee
ong
oing
mon
itorin
g of
DSR
IP p
roje
cts i
nclu
ding
ons
ite
visit
s.
94
INDE
PEN
DEN
T EV
ALUA
TOR
The
stat
e w
ill c
ontr
act w
ith a
n in
depe
nden
t ent
ity, w
ith e
xper
tise
in
deliv
ery
syst
em im
prov
emen
t and
pro
gram
eva
luat
ion,
to se
rve
as th
e ev
alua
tor o
f the
DSR
IP p
rogr
am.
•In
depe
nden
t eva
luat
or w
ill:
W
ork
in c
olla
bora
tion
with
the
inde
pend
ent a
sses
sor;
As
sist w
ith c
ontin
uous
qua
lity
impr
ovem
ent a
ctiv
ities
;
Perf
orm
dat
a an
alys
is ev
alua
tion
on c
linic
al &
pop
ulat
ion
focu
sed
impr
ovem
ents
; and
Prep
are
a su
mm
ativ
e an
d fin
al e
valu
atio
n.
95
DSRI
P TI
MEL
INE
Due
Date
/Sub
mis
sion
Dat
e Ac
tivity
/Del
iver
able
Ap
ril -
May
201
4
CMS
appr
oves
STC
s and
DSR
IP A
ttac
hmen
ts
New
Yor
k po
sts
the
DSRI
P Fu
ndin
g an
d M
echa
nics
Pro
toco
l an
d th
e DS
RIP
Stra
tegi
es M
enu
and
Met
rics
for p
ublic
co
mm
ent f
or 3
0 da
ys
New
Yor
k po
sts
IAAF
Qua
lific
atio
ns a
nd A
pplic
atio
n on
for
publ
ic c
omm
ent f
or 1
4 da
ys;
14 d
ay IA
AF a
pplic
atio
n pe
riod
begi
ns o
nce
com
men
t per
iod
clos
es
IAAF
aw
ards
can
be
dist
ribut
ed a
fter 1
4 da
y ap
plic
atio
n pe
riod
clos
es
Stat
e ha
s 10
days
to su
bmit
its fi
rst r
epor
t for
IAAF
pay
men
ts
(STC
1(b
)(iii)
(A) o
f thi
s se
ctio
n)
Stat
e w
ill m
ake
base
line
data
for D
SRIP
mea
sure
s av
aila
ble
Stat
e su
bmits
its p
ropo
sed
inde
pend
ent a
sses
s st
atem
ent o
f w
ork
(SO
W) f
or it
s ind
epen
dent
ass
esso
r con
trac
t pr
ocur
emen
t
DSRI
P TI
MEL
INE
97
DSRI
P TI
MEL
INE
Du
e Da
te/S
ubm
issi
on D
ate
Activ
ity/D
eliv
erab
le
May
- Ju
ly 2
014
Stat
e m
ust a
ccep
t DSR
IP S
TCs o
r offe
r tec
hnic
al c
orre
ctio
ns,
incl
udin
g fo
r the
DSR
IP O
pera
tiona
l Pro
toco
l and
the
Qua
rter
ly
Repo
rtin
g fo
rmat
s St
ate
has 1
0 da
ys to
subm
it ch
ange
s to
the
DSRI
P Fu
ndin
g an
d M
echa
nics
Pro
toco
l and
the
DSRI
P St
rate
gies
Men
u an
d M
etric
s on
ce p
ublic
com
men
t per
iod
clos
es
CMS
will
revi
ew c
hang
es to
the
DSRI
P Fu
ndin
g an
d M
echa
nics
Pr
otoc
ol a
nd D
SRIP
Str
ateg
ies M
enu
and
Met
rics a
nd ta
ke
actio
n no
late
r tha
n 30
day
s afte
r sta
te su
bmits
cha
nges
St
ate
acce
pts D
SRIP
Des
ign
Gran
t app
licat
ions
and
mak
e De
sign
Gran
t aw
ards
St
ate
post
s DS
RIP
Proj
ect P
lan
Revi
ew To
ol th
at in
depe
nden
t as
sess
or w
ill u
se to
scor
e su
bmitt
ed D
SRIP
Pro
ject
Pla
n ap
plic
atio
ns fo
r 30
days
98
DSRI
P TI
MEL
INE
Du
e Da
te/S
ubm
issi
on D
ate
Activ
ity/D
eliv
erab
le
Augu
st 1
, 201
4 St
ate
subm
its d
raft
DSR
IP e
valu
atio
n de
sign
Augu
st 3
0, 2
014
Stat
e su
bmits
its f
irst q
uart
erly
repo
rt, i
nclu
ding
its
oper
atio
nal r
epor
t (ST
Cs 3
5 &
36)
O
ctob
er 1
, 201
4 St
ate
subm
its it
s Im
prov
ed M
anag
emen
t Con
trol
s rep
ort t
o CM
S
Stat
e ac
cept
s DSR
IP P
roje
ct P
lan
appl
icat
ions
Stat
e w
ill p
erfo
rm in
itial
revi
ew o
f sub
mitt
ed D
SRIP
Pro
ject
Pl
an a
pplic
atio
ns
In
depe
nden
t ass
esso
r will
per
form
full
revi
ew o
f DSR
IP p
roje
ct
plan
app
licat
ions
Inde
pend
ent a
sses
sor w
ill p
ost r
evie
wed
DSR
IP P
roje
ct P
lan
appl
icat
ions
for p
ublic
com
men
t for
30
days
99
DSRI
P TI
MEL
INE
AFTE
R JA
NUA
RY 1
, 201
5
New
Yor
k Pa
rtne
rshi
p Pl
an R
enew
al P
erio
d –
Janu
ary
1, 2
015
In
depe
nden
t ass
esso
r app
rova
l rec
omm
enda
tions
mad
e pu
blic
Stat
e Di
strib
utes
DSR
IP P
roje
ct P
lan
awar
ds fo
r app
rove
d pe
rfor
min
g
prov
ider
syst
ems
Q
uart
erly
Del
iver
able
s – Q
uart
erly
Rep
ort a
nd O
pera
tiona
l Rep
ort
Augu
st 3
0, 2
014;
Nov
embe
r 30,
201
4; F
ebru
ary
28, 2
015;
May
30,
201
5
100
MRT
WAI
VER
AMEN
DMEN
T:
STAK
EHO
LDER
EN
GAGE
MEN
T PR
OCE
SS
MRT
WAI
VER
AMEN
DMEN
T: P
UBL
IC C
OM
MEN
T PR
OCE
SS
New
Yor
k is
requ
ired
to se
ek p
ublic
com
men
t on
Atta
chm
ents
I an
d J.
In
addi
tion,
New
Yor
k w
ill se
ek p
ublic
com
men
t on
the
MRT
Wai
ver
Amen
dmen
t STC
s.
Publ
ic C
omm
ent p
erio
ds:
M
RT W
aive
r Am
endm
ent S
TCs:
(15
days
)
At
tach
men
ts I
and
J pub
lic c
omm
ent p
erio
d: (3
0 da
ys)
Publ
ic c
omm
ent s
umm
arie
s and
resp
onse
s will
be
post
ed to
the
MRT
w
ebsit
e, a
nd A
ttac
hmen
ts I
and
J will
be
upda
ted
(with
CM
S ap
prov
al)
base
d on
pub
lic c
omm
ent r
ecei
ved.
DS
RIP
e-m
ail –
dsr
ip@
heal
th.s
tate
.ny.
us
102
PUBL
IC M
EETI
NG
S
Five
pub
lic m
eetin
gs a
re b
eing
hel
d th
roug
hout
the
answ
er q
uest
ions
and
so
licit
com
men
ts fr
om N
ew Y
orke
rs.
103
Publ
ic M
eetin
g Da
te
Tim
e/Lo
catio
n
Roch
este
r: T
uesd
ay, A
pril
15:
8:30
a.m
. – 1
1:30
a.m
. Uni
vers
ity o
f Ro
ches
ter,
Mem
oria
l Art
Gal
lery
– R
oche
ster
Syra
cuse
: T
uesd
ay, A
pril
15:
2:00
p.m
. - 5
:00
p.m
. Cr
owne
Pla
za,
Lafa
yett
e Ro
om –
Syr
acus
e
Capi
tal D
istric
t: W
edne
sday
, Apr
il 16
10
:00
a.m
. - 1
:00
p.m
. U
nive
rsity
at A
lban
y,
Scho
ol o
f Pub
lic H
ealth
– R
enns
elae
r
NYC
: T
hurs
day,
Apr
il 17
12
:00
p.m
. – 3
:00
p.m
. N
ew Yo
rk C
ity C
olle
ge
of Te
chno
logy
, Atr
ium
Am
phith
etae
r –
Broo
klyn
Buffa
lo :
TBD
TB
D
Su
bscr
ibe
to o
ur li
stse
rv:
http
://w
ww
.hea
lth.n
y.go
v/he
alth
_car
e/m
edic
aid/
rede
sign/
lists
erv.h
tm
We
wan
t to
hear
from
you
! DS
RIP
e-m
ail:
dsrip
@he
alth
.stat
e.ny
.us
‘Lik
e’ th
e M
RT o
n Fa
cebo
ok:
http
://w
ww
.face
book
.com
/New
York
MRT
Follo
w th
e M
RT o
n Tw
itter
: @N
ewYo
rkM
RT
Centers for Medicare and Medicaid Services (CMS) Official Documents:
MRT Waiver Amendment/DSRIP Special Terms and Conditions (STCs)
[MRT Waiver Amendment STCs outline implementation of MRT Waiver Amendment programs, authorized funding sources and uses, and other requirements.]
Partnership Plan - Approval Period: August 1, 2011 – December 31, 2014; as Amended April 14, 201444
m. The state may claim as allowable expenditures under the demonstration the payments made through its state-funded program to provide subsidies for parents and caretaker relatives with incomes above 133 percent of the FPL through 150 percent of the FPL who purchase health insurance through the Marketplace. Subsidies will be provided on behalf of individuals who: (1) are not Medicaid eligible but who are parents or caretaker relatives of individuals under the age of 21; (2) are eligible for the advance premium tax credit (APTC); and (3) whose income is above 133 percent of the FPL through 150 percent of the FPL. Federal financial participation for the premium assistance portion of QHP subsidies for citizens and eligible qualified aliens will be provided through the Designated State Health Programs pursuant to this STC. Authority to claim federal matching for this program will end on December 31, 2014.
n. The state may claim as allowable expenditures under the demonstration, the payments made through its state-funded program to provide FHPlus benefits to parents and caretaker relatives with incomes up to and including 150 percent of the FPL who are no longer eligible under the demonstration. Authority to claim federal matching for this program will end on December 31, 2014.
13. Designated State Health Programs (DSHP) Claiming Process.
a. Documentation of each DSHP’s expenditures must be clearly outlined in the state's supporting work papers and be made available to CMS.
b. Federal funds must be claimed within two years after the calendar quarter in which the state disburses expenditures for the DSHPs in STC 12 of this section. Claims may not besubmitted for state expenditures disbursed after December 31, 2014.
c. Sources of non-federal funding must be compliant with section 1903(w) of the Act and applicable regulations. To the extent that federal funds from any federal programs are received for the DSHPs listed in STC 12 of this section, they shall not be used as a source of non-federal share.
d. The administrative costs associated with DSHPs in STC 12 of this section and any others subsequently added by amendment to the demonstration shall not be included in any way as demonstration and/or other Medicaid expenditures.
e. Any changes to the DSHPs listed in STC 12 of this section shall be considered an amendment to the demonstration and processed in accordance with STC 7 in Section III.
VIII. DELIVERY SYSTEM REFORM PROGRAM DESCRIPTION AND
OBJECTIVES
1. Medicaid Redesign Team (MRT)
a. BACKGROUND
The purpose of this demonstration amendment is to describe a structure under which the federal government will provide up to $8 billion in new federal funds for all Medicaid Redesign Team (MRT) activities including delivery system reform in the waiver, managed care programming and state plan amendment (SPA) activities. The purpose of one component of MRT, the
Partnership Plan - Approval Period: August 1, 2011 – December 31, 2014; as Amended April 14, 201445
Delivery System Reform Incentive Payment (DSRIP) program, is to provide incentives for Medicaid providers to create and sustain an integrated, high performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low income uninsured individuals in their local communities by improving care, improving health and reducing costs. Up to $6.42 billion of the new MRT funding is available for DSRIP payments to providers. An additional $500 million in temporary, time limited, funding is available from an Interim Access Assurance Fund (IAAF) for payments to providers to protect against degradation of current access to key health care services in the near term. And, up to $1.08 billion in federal funding for non-DSRIP Medicaid Redesign purposes, with specific uses of that funding still to be discussed and finalized.
Only initial funding of this structure is authorized in 2014; continued authority for operations and funding must be authorized upon renewal of the overall Partnership Plan demonstration, and is contingent on satisfactory initial implementation.
The DSRIP program is focused on the following goals: (1) safety net system transformation at both the system and state level; (2) accountability for reducing avoidable hospital use and improvements in other health and public health measures at both the system and state level; and (3) efforts to ensure sustainability of delivery system transformation through leveraging managed care payment reform.
i. Safety Net System Transformation. The DSRIP funds provider incentive payments to reward safety net providers when they undertake projects designed to transform the systems of care that support Medicaid beneficiaries and low income uninsured by addressing three key elements, which must be reflected in all DSRIP projects proposed by safety net providers participating in DSRIP (referred to as “Performing Provider Systems”). DSRIP projects will be designed to meet and be responsive to community needs while ensuring overall transformation objectives are met. As such, all projects must include the following elements, whose core components and associated outcome measures are further described in the DSRIP Strategies Menu and Metrics (Attachment J):
A. Element 1: Appropriate Infrastructure. The DSRIP will further the evolution of infrastructure and care processes to meet the needs of their communities in a more appropriate, effective and responsive fashion to meet key functional goals. This will include changes in the workforce. Infrastructure evolution must support the broader goals of DSRIP, and key outcomes reflect the kinds of infrastructure to be supported under DSRIP. Appropriate infrastructure should ensure access to care, particularly to outpatient resources as well as effective care integration. In support of linking settings, the transforming infrastructure should place more emphasis on outpatient settings. Also, critical services such as care coordination may need to be expanded to meet the broad needs of the population served.
Indicators related to this objective are included in the System Transformation Milestones (Domain 2) described in more detail in DSRIP Strategies Menu and Metrics (Attachment J). Because many of these indicators are difficult to benchmark, the state will be
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accountable for ensuring that these indicators are moving overall in the right directions across all systems as part of the statewide accountability described in STC 14 (f) of this section.
B. Element 2: Integration across settings. The DSRIP will further the transformation of patient care systems to create strong links between different settings in which care is provided, including inpatient and outpatient settings, institutional and community based settings, and importantly behavioral and physical health providers. The goal will be to coordinate and provide care for patients across the spectrum of settings in order to promote health and better outcomes, particularly for populations at risk, while also managing total cost of care. The DSRIP will fund projects that include new and expanded care coordination programs, other evidence based, data driven interventions and programs focused on key health and cost drivers and opportunities for providers to share information and learn from each other.
Key outcomes to be measured are expected to reflect this ongoing transformation. Integration across settings will create alignments between providers. The DSRIP will include restructuring payments to better reward providers for improved outcomes and lower costs.
Indicators related to this objective are included in the Clinical Improvement Milestones (Domain 3) described in more detail in DSRIP Strategies Menu and Metrics (Attachment J). Each system will be accountable for these indicators, and in addition, because the state should also work to support this goal, the state will also be accountable for statewide performance on these outcomes as described in STC 14(g) of this section.
C. Element 3: Assuming responsibility for a defined population. The DSRIP projects will be designed in ways that promote integrated systems assuming responsibility for the overall health needs of a population of Medicaid beneficiaries and low income uninsured people, not simply responding to the patients that arrive at the doors of a hospital. The state will approve a defined population for each DSRIP project based on geographic and member service loyalty factors, as described in DSRIP Program Funding and Mechanics Protocol (Attachment I). Safety net providers may propose to develop integrated systems that target the individuals served by a set of aligned community-based providers, or more ambitious systems to tackle accountability for an entire geographic population. Patient and beneficiary engagement through tools including community needs assessment and responsiveness to public health needs will be an important element of all DSRIP projects.
Each indicator used to determine DSRIP awards should reflect a population, rather than the patients enrolled in a particular intervention. In addition, DSRIP performing provider systems will be required to report on progress on priorities related to the Prevention Agenda as included in the Population-wide Strategy
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Implementation Milestones (Domain 4) described in more detail in DSRIP Strategies Menu and Metrics (Attachment J).
D. Element 4: Procedures to reduce avoidable hospital use: guidepost for
statewide reform. New York has identified a statewide goal of reducing avoidable hospital use and improving outcomes in other key health and public health measures. Effectively reducing avoidable hospital use requires alignment of outpatient and inpatient settings, requires systems that can take responsibility for a population, and requires investments in key infrastructure--and so this is a guidepost that can ensure that these transformations are aligned with our shared goals of better health, and better care at lower cost.
Consistent with the fact that this is an integral guidepost to system transformation, key improvement outcomes for avoidable hospital use and improvements in other health and public health measures will be included for each project, and the state will be held accountable for these measures as part of the statewide accountability described in STC 14 (f) of this section.
E. Element 5: State managed care contracting reforms to establish and promote
DSRIP objectives. The state must also ensure that its managed care payment systems recognize, encourage and reward positive system transformation. To fully accomplish DSRIP goals and ensure sustainability of the initiatives supported by this demonstration, as a condition of receiving DSRIP project funding, the state shall develop and execute payment arrangements and accountability mechanisms with its managed care contractors. These payment and accountability changes, described further in STC 39 of this section, must be reflected in the state’s approved state plan and managed care contracts, and are funded through the approved state plan (without separate DSRIP funding). These changes are a condition for overall DSRIP project funding to be released.
This goal will also be monitored as part of the statewide accountability test described in STC 14(f) of this section and will be tracked not at a DSRIP project level, but at the state level. The state must ensure state payments to managed care plans reflect and promote the establishment and continuation of integrated service delivery systems and procedures to reduce avoidable hospital use and ensure improvements in other health and public health measures.
ii. State and Provider Accountability. Overall DSRIP project funding is available up to the amounts specified in the special terms and conditions. Such funding is subject to the Performing Provider System meeting ongoing milestones established pursuant to this demonstration, and the state meeting overall state milestones as described in the STCs and DSRIP Program Funding and Mechanics Protocol (Attachment I). In addition, statewide achievement of performance goals and targets must be achieved and maintained for full access to the funding level as specified in the STCs. Specific reductions from statewide funds are taken from the state starting in Year 3 accordance with STC 14 (h) of this section if these targets are not achieved.
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Individual projects are awarded based on the merit of the proposal itself, its support of the overall DSRIP goals, and the projected breadth and depth of the impact on Medicaid beneficiaries. Public transparency, a process that allows for community input, and independent expert evaluation are critical to the approval and funding levels for each project.
It should be noted that federal funding for DSRIP activities is limited in any phase of the demonstration period to the amounts set forth in this demonstration authority, subject to all of the reductions based on milestones, even if the state expenditures exceed the amount for which federal funding is available.
b. Interim Access Assurance Fund (IAAF). Temporary, time limited, funding is available from an IAAF to protect against degradation of current access to key health care services in the near term. The IAAF is available to provide supplemental payments that exceed upper payment limits, DSH limitations, or state plan payments, to ensure that current trusted and viable Medicaid safety net providers, according to criteria established by the state consistent with these STCs, can fully participate in the DSRIP, transformation without unproductive disruption. The IAAF is authorized as a separate funding structure from the DSRIP program to support the ultimate achievement of DSRIP goals. To the extent available funds are not expended in this time-limited IAAF, they are available for the DSRIP program itself. In addition, a separate fund is authorized to make DSRIP project design grants to providers. The IAAF and the design grant funds are both part of the overall DSRIP total funding.
i. Interim Access Assurance Fund. To protect against degradation of current access to key health care services, limit unproductive disruption, and avoid gaps in the healthdelivery system, New York is authorized to make payments for the financial support of selected Medicaid providers.
A. Limit on FFP. New York may expend up to $500 million in FFP for Interim Access Assurance payments for the period from the date of approval of the IAAF expenditure authority until December 31, 2014. Contingent upon renewal of the demonstration, the authority could be extended until March 31, 2015. To the extent available funds are not expended in this time-limited IAAF, they are available for the DSRIP program itself.
B. Funding. The non-federal share of IAAF payments may be funded by state general revenue funds and transfers from units of local government that are compliant with section 1903(w) of the Act. Any IAAF payments must remain with the provider receiving the payment to be used for health care related purposes, and may not be transferred back to any unit of government, directly or indirectly, or redirected for other purposes. The IAAF payments received by providers cannot be used for the non-federal share of any expenditures claimed under a federally-supported grant.
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ii. Interim Access Assurance Fund Requirements.
A. The state will make all decisions regarding the distribution of IAAF payments to ensure that sufficient numbers and types of providers are available to Medicaid beneficiaries in the geographic area to provide access to care for Medicaid and uninsured individuals while the state embarks on its transformation path. The IAAF payments shall be limited to providers that serve significant numbers of Medicaid individuals, and that the state determines have financial hardship in the form of financial losses or low margins. In determining the qualifications of a safety net provider for this program and the level of funding to be made available, the state will take into consideration both whether the funding is necessary (based on current financial and other information on community need and services) to provide access to Medicaid and uninsured individuals. The state will also seek to ensure that IAAF payments supplement but do not replace other funding sources.
B. Before issuing any payments to providers, the state must post on its Website a list of qualifications that providers must meet to receive payments under this section,provide an opportunity for public comment for at least 14 days, and consider such comments. On the day the proposed qualifications list is posted, the state must provide to CMS the URL where the list can be found. The state must take the public comments into account when qualifying providers and distributing funds from this account.
C. Following the end of the public comment period in (ii), the state will initiate an open application period of at least 14 days duration for providers to submit applications.
D. If a provider otherwise meeting the qualifications of this section is also receiving funds through the state’s vital access program, or any other supplemental payment program for which the federal government provides matching funds, or Medicaid disproportionate share hospital payments, the state must assure CMS of non-duplication. As part of the reporting requirements described in (iii) below, the state assures that the payment information for the IAAF will be maintained, as the reporting information is subject to CMS audit. A provider may receive both funding through this special fund and a planning grant as part of the DSRIP program.
iii. Reporting.
A. Within 10 days of initiating payments under this section to a provider, the state must submit a report to CMS that states the total amount of the payment or payments, the amount of FFP that the state will claim, the source of the non-Federal share of the payments, and documentation of the needs and purposes of the funds to assure CMS of non-duplication. The state should document all other Medicaid payments (e.g. base, supplemental, VAP, DSH) the provider receives to demonstrate that existing payments are not sufficient to meet financial needs of
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the providers.
B. In each quarterly progress report, the state will include a summary of all payments under this section made during the preceding quarter, including all information required in (A), and attach copies all reports submitted under (A) for payments made during the quarter.
C. When reporting payments under this section on the CMS-64, the state must include in Form CMS-64 Narrative a table that lists all payments by date, provider, and amount (broken down by source), and a reference to the quarterly progress report(s) where the payments and all of their required supporting documentation is presented.
iv. IAAF payments. The IAAF payments are not direct reimbursement for expenditures or payments for services. Payments from the IAAF are not considered patient care revenue, and shall not be offset against disproportionate share hospital expenditures or other Medicaid expenditures that are related to the cost of patient care (including stepped down costs of administration of such care) as defined under these STCs, and/or under the state plan.
c. Delivery System Reform Incentive Payment (DSRIP) Fund. The terms and conditions in Section c apply to the State’s exercise of Expenditure Authority 9: Expenditures Related to the Delivery System Reform Incentive Payment (DSRIP) Fund. These requirements are further elaborated by Attachment I, “NY DSRIP Program Funding and Mechanics Protocol,” Attachment J “NY DSRIP Strategies Menu and Metrics,” and Attachment K “DSRIP Operational Protocol.” For purposes of this section, the DSRIP program will have its own demonstration years (DY) and any reference to DY is in reference to the DSRIP portion of the Partnership Plan demonstration and not the entire Partnership Plan demonstration. DSRIP funding for demonstration year DY 1 through DY 5 is contingent on renewal of the demonstration no later than December 31, 2014 and the revision of Attachments I, J and K based on the pre-implementation activities described in this section.
As described further below, DSRIP funding is available to Performing Provider Systems
that consist of safety net providers whose project plans are approved and funded through the process described in these STCs and who meet particular milestones described in their approved DSRIP project plans. DSRIP project plans are based on the evidenced-based projects specified in the DSRIP Strategies Menu and Metrics (Attachment J) and are further developed by Performing Provider Systems to be directly responsive to the needs and characteristics of the low-income communities that they serve and to achieve the transformation objectives furthered by this demonstration.
2. Safety Net Definition: The definition of safety net provider for hospitals will be based on the environment in which the performing provider system operates. Below is the safety net definition:
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a. A hospital must meet the following criteria to participate in a performing provider system:
i. Must be either a public hospital, Critical Access Hospital or Sole Community Hospital, or
ii. Must pass two tests:A. At least 35 percent of all patient volume in their outpatient lines of business must
be associated with Medicaid, uninsured and Dual Eligible individuals.B. At least 30 percent of inpatient treatment must be associated with Medicaid,
uninsured and Dual Eligible individuals; or
iii. Must serve at least 30 percent of all Medicaid, uninsured and Dual Eligible members in the proposed county or multi-county community. The state will use Medicaid claims and encounter data as well as other sources to verify this claim. The state reserves the right to increase this percentage on a case by case basis so as to ensure that the needs of each community’s Medicaid members are met.
b. Non-hospital based providers, not participating as part of a state-designated health home, must have at least 35 percent of all patient volume in their primary lines of business andmust be associated with Medicaid, uninsured and Dual Eligible individuals.
c. Vital Access Provider Exception: The state will consider exceptions to the safety net definition on a case-by-case basis if it is deemed in the best interest of Medicaid members. Any exceptions that are considered must be approved by CMS and must be posted for public comment 30 days prior to application approval. Three allowed reasons for granting an exception are:
i. A community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.
ii. 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.
iii. Any state-designated health home or group of health homes.
d. Non-qualifying providers can participate in Performing Providers Systems. However, non-qualifying providers are eligible to receive DSRIP payments totaling no more than 5 percent of a project’s total valuation. CMS can approve payments above this amount if itis deemed in the best interest of Medicaid members attributed to the Performing Provider System.
3. Performing Provider Systems. The safety net providers that are funded to participate in a DSRIP project are called “Performing Provider Systems.” Performing Provider Systems that complete project milestones and measures as specified in Attachment J, “DSRIP Strategies
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Menu and Metrics”, are the only entities that are eligible to receive DSRIP incentive payments.
4. Two DSRIP Pools. Performing Provider Systems will be able to apply for funding from one of two DSRIP pools: Public Hospital Transformation Fund and Safety Net Performance Provider System Transformation Fund.
a. The Public Hospital Transformation Fund will be open to applicants led by a major public hospital system. The public hospital systems allowed to participate in this pool include:
i. Health and Hospitals Corporation of New York Cityii. State University of New York Medical Centers
iii. Nassau University Medical Centeriv. Westchester County Medical Centerv. Erie County Medical Center
b. The Safety Net Performance Provider System Transformation Fund would be available to all other DSRIP eligible providers.
c. Allocation of funds between the two pools will be determined after applications have been submitted, based on the valuation of applications submitted to each pool. The valuation framework is described in STC 9 of this section and will be further specified in the Program Funding and Mechanics Protocol.
d. There is also a Performance Pool within the two DSRIP pools, as described in the Program Funding and Mechanics Protocol (Attachment I).
5. Coalitions and Attributed Population. Major public general hospitals and other safety net providers are strongly required to form coalitions that apply collectively as a single Performing Provider System. Coalitions will be evaluated on performance on DSRIP milestones collectively as a single Performing Provider System. Coalitions are subject to the following conditions in addition to the requirements specified in the Program Funding and Mechanics Protocol:
a. Coalitions must designate a lead coalition provider who will be held responsible under the DSRIP for ensuring that the coalition meets all requirements of Performing Provider Systems, including reporting to the state and CMS.
b. Coalitions must establish a clear business relationship between the component providers, including a joint budget and funding distribution plan that specifies in advance the methodology for distributing funding to participating providers. The funding distribution plan must comply with all applicable laws and regulations, including, but not limited to,the following federal fraud and abuse authorities: the anti-kickback statute (sections 1128B(b)(1) and (2) of the Act); the physician self-referral prohibition (section 1903(s) of the Act); the gainsharing civil monetary penalty (CMP) provisions (sections 1128A(b)(1)
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and (2) of the Act); and the beneficiary inducement CMP (section 1128A(a)(5) of the Act). CMS approval of a DSRIP plan does not alter the responsibility of Performing Provider Systems to comply with all federal fraud and abuse requirements of the Medicaid program.
c. Each Performing Providers System must, in the aggregate, identify a proposed population for DSRIP. The proposed population will be aligned with the population attribution methodology specified in the Program Funding and Mechanics Protocol. The attribution methodology will assure non-duplication of members between DSRIP Performing Providers Systems.
d. Each coalition must have a data agreement in place to share and manage data on system-wide performance.
6. Objectives. Performing Provider Systems will design and implement projects that aim to achieve each of the following objectives or sub-parts of objectives, which are elaborated further in the DSRIP Strategies Menu and Metrics (Attachment J). To put in the context of the overall three objectives below, each performing provider system is responsible for project activity that addresses the first two objectives, for a defined population as specified in the third objective.
a. The creation of appropriate infrastructure and care processes based on community need, in order to promote efficiency of operations and support prevention and early intervention.
b. The integration of settings through the cooperation of inpatient and outpatient, institutional and community based providers, in coordinating and providing care for patients across the spectrum of settings in order to promote health and better outcomes, particularly for populations at risk, while managing total cost of care.
c. Population health management as described in the attribution section of the Program Funding and Mechanics Protocol.
7. Project Milestones. Progress towards achieving the goals specified above will be assessed by specific milestones for each project, which are measured by particular metrics that are further defined in the DSRIP Strategies Menu and Metrics (Attachment J). These milestones are organized into the following domains:
a. Project progress milestones (Domain 1). Investments in technology, tools, and human resources that will strengthen the ability of the Performing Provider Systems to servetarget populations and pursue DSRIP project goals. Performance in this domain is measured by a common set of project progress milestones, which will include milestones related to the monitoring of project spending and post-DSRIP sustainability. This includes at least semi-annual reports on project progress specific to the performing provider system’s DSRIP project and its Medicaid and uninsured patient population.
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b. System transformation milestones (Domain 2). As described further in the Project Menu, this includes outcomes that reflect the four subparts of the goal on system transformation, including measures of inpatient/ outpatient balance, increased primary care/community-based services utilization, and rates of global capitation, partial capitation and bundled payment of providers by Medicaid managed care plans, and measures for patient engagement.
c. Clinical improvement milestones (Domain 3): As described further in the Project Menu, this domain includes metrics that reflect improved quality of care for Medicaid beneficiaries; including the goal of reducing avoidable hospital use and improvements in other health and public health measures. Payment for performance on these outcome milestones will be based on an objective demonstration of improvement over a baseline, using a valid, standardized method. Systems that are already high performers on these metrics, with the exception of avoidable hospitalization metrics, before initiation of projects must either explore alternative projects or align with lower performing providers such that the system as a whole has adequate room for improvement (as defined in DSRIP Program Funding and Mechanics Protocol (Attachment I).
d. Population-wide Strategy Implementation Milestones (Domain 4). DSRIP Performing Provider Systems will be responsible for reporting on progress on strategies they have chosen related to the Prevention Agenda as identified in DSRIP Strategies Menu and Metrics (Attachment J) for relevant populations as identified in DSRIP Program Funding and Mechanics Protocol (Attachment I) and as approved in their project plan.
8. DSRIP Project Plan Performing Provider Systems must develop a DSRIP project plan that is based on one or more of the projects specified in the DSRIP Strategies Menu and Metrics (Attachment J) and complies with all requirements specified in the DSRIP Program Funding and Mechanics Protocol. Performing Provider Systems should develop DSRIP project plans, while leveraging community needs, including allowing community engagement during planning, to sufficiently address the delivery system transformation achievement that is expected from their projects. DSRIP project plans will be provided in a structured format developed by the state and approved by CMS and must be tracked by the state over the duration and close out of the program. DSRIP project plans must be approved by the state and may be subject to additional review by CMS, DSRIP project plans must include the following elements:
a. Rationale for Project Selection.
i. Each DSRIP project plan must identify the target populations, program(s), and specific milestones for the proposed project, which must be chosen from the options described in the approved DSRIP Strategies Menu and Metrics.
ii. Goals of the project plan should be aligned with each of the objectives as described in STC 6 of this section.
iii. Milestones should be organized as described above in STC 7 of this section reflecting
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the three overall goals and subparts for each goal as necessary.
iv. The project plan must describe the need being addressed and the starting point (including baseline data consistent with the agreement between CMS and the state) of the performing provider system related to the project. The starting point of the project plan must be after April 1, 2015.
v. Based on the starting point the performing provider system must describe its 5-year expected outcome for each of the domains described in STC 7 of this section.Supporting evidence for the potential for the interventions to achieve these changes should be provided in support of this 5 year projection for achievement in the goals of this DSRIP.
vi. The DSRIP Project Plan shall include a description of the processes used by the Performing Provider System to engage and reach out to stakeholders, including a plan for ongoing engagement with the public, based on the process described in the Operational Protocol (Attachment K).
vii. Performing Provider Systems must demonstrate how the project will transform the delivery system for the target population and do so in a manner that is aligned with the central goals of DSRIP, and in a manner that will be sustainable after DY5. The projects must implement new, or significantly enhance existing health care initiatives; to this end, providers must identify the CMS and HHS funded delivery system reform initiatives in which they currently participate or in which they have participated in the previous five years, and explain how their proposed DSRIP activities are not duplicative of activities that are already or have recently been funded.
viii. The plan must include an approach to rapid cycle evaluation that informs the system in a timely fashion of its progress, how that information will be consumed by the system to drive transformation and who will be accountable for results, including the organizational structure and process to oversee and manage this process. The plan must also indicate how it will tie into the state’s requirement to report to CMS on a rapid cycle basis.
ix. The plan must contain a comprehensive workforce strategy. This strategy will identify all workforce implications – including employment levels, wages and benefits, and distribution of skills – and present a plan for how workers will be trained and deployed to meet patient needs in the new delivery system. Applicantswill need to include workers and their representatives in the planning and implementation of their workforce strategy.
b. Description of Project Activities.
i. Each project must feature strategies from all domains described in STC 7 of this section and the DSRIP Strategies Menu and Metrics.
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ii. For each domain of a project, there must be at least one associated outcome metric that must be reported in all years, years 1 through 5. The initially submitted DSRIP project plan must include baseline data on all measures, should demonstrate the ability to provide valid data and provide benchmarks for each measure. Baseline measurements should be based on the most recently available baseline data, as agreed to by CMS and the state.
c. Justification of Project Funding.
i. The DSRIP project plan shall include a detailed project specific budget as provided for in DSRIP Program Funding and Mechanics Protocol (Attachment I) and a description of the performing provider system or provider coalition’s overall approach to valuing the project. Project valuations will be subject to a standardized analysis by the state as described below and further specified in the Program Funding and Mechanics Protocol.
ii. DSRIP project plans shall include any information necessary to describe and detail mechanisms for the state to properly receive intergovernmental transfer payments (as applicable and further described in the program funding and mechanics protocol).
9. Project Valuation. DSRIP payments are earned for meeting the performance milestones (as specified in each approved DSRIP project plan). The value of funding for each milestone and for DSRIP projects overall should be proportionate to and its potential benefit to the health and health care of Medicaid beneficiaries and low income uninsured individuals, as further explained in the Program Funding and Mechanics Protocol (Attachment I).
a. Maximum project valuation. As described further in the Program Funding and Mechanics Protocol, a maximum valuation for each project on the project menu shall be calculated based on the following valuation components as specified in the Program Funding and Mechanics Protocol (Attachment I).
i. Index score of transformation potential. The state will use a standardized index to score each project on the project menu, based on its anticipated delivery system transformation. This index will include factors of anticipated transformation, such as potential for achieving the goals of DSRIP outlined in STC 6 of this section, expected cost savings, potential to reduce preventable events, capacity of the project to directly affect Medicaid and uninsured beneficiaries and robustness of evidence base. The index scoring process is described in the DSRIP Program and Funding and Mechanics Protocol and will be available for public comment in accordance with STC 10 of this section.
ii. Valuation benchmark. The project index score will be multiplied by a valuation benchmark in combination with the components below for all DSRIP projects in order to determine the maximum valuation for the project, as specified in the Program Funding and Mechanics Protocol (Attachment I). The valuation benchmark should be externally justified based on evidence for the value and scope of similar system
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transformations and delivery system reforms, and may not be based on the total statewide limit on DSRIP funding described in STC 14 of this section. By no later than 15 days after the public comment period for initial DSRIP applications, the state will establish a state-wide valuation benchmark based on its assessment of the cost of similar delivery reforms. This value will be expressed in a per member per month (PMPM) format and may not exceed $15 PMPM, calculated multiplying paragraphs (iii)(B) and (C) below.
iii. DSRIP Project Plan Application Score. Based on the Performing Provider System’s application, each project plan will receive a score based on the following:
A. The fidelity to the project description, and likelihood of achieving improvement by using that project.
B. Number of beneficiaries attributed to each performing provider’s project plan. C. Number of DSRIP months that will be paid for under the DSRIP project plan.
b. Progress milestones and outcome milestones. A DSRIP project’s total valuation will be distributed across the milestones described in the DSRIP project plan, according to the specifications described in the Program Funding and Mechanics Protocol (Attachment I).An increasing proportion of DSRIP funding will be allocated to performance on outcome milestones each year, as described in DSRIP Program Funding and Mechanics Protocol (Attachment I).
c. Performance based payments. Performing Provider Systems may not receive payment for metrics achieved prior to the baseline period set by CMS and the State in accordance with these STCs and the funding and mechanics protocol and achievement of all milestones is subject to audit by CMS, the state, and the state’s independent assessor described in STC 10 of this section. The state shall also monitor and report proper execution of project valuations and funds distribution as part of the implementation monitoring reporting required under STC 12 of this section. In addition to meeting performance milestones, the state and performing providers must comply with the financial and reporting requirements for DSRIP payments specified in STC 13 of this section and any additional requirements specified in the Program Funding and Mechanics Protocol (Attachment I).
10. Pre-implementation activities. In order to authorize DSRIP funding for DY 1 to 5, the statemust meet the following implementation milestones according to the timeline outlined in these STCs and must successfully renew the demonstration according to the process outlined in STC 8 in Section III. Failure to complete these requirements will result in a state penalty, as described in paragraph (vi) below.
a. Project Design Grants. During calendar year 2014, the state may provide allotted amounts to providers for DSRIP Design Grants from a designated Design Grant Fund. These grants will enable providers to develop specific and comprehensive DSRIP Project Plans. New York may expend up to $100 million in FFP for the grant payments from the
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Design Grant Fund. Unspent funds will be carried over to DSRIP. DSRIP Project Design Grant payments count against the total amounts allowed for DSRIP under the demonstration.
i. Submitting a proposal for a DSRIP Project Design Grant. Providers and coalitions must submit a DSRIP design proposal as an application for a design. The state will review proposals and award design grants at any time during the pre-implementation activities.
ii. Use of Design Grant Funds. The providers and coalitions that receive DSRIP project design grants must use their grant funds to prepare a DSRIP project plan to prepare the provider’s application for a DSRIP award. Providers and coalitions that receive DSRIP project design grants must submit a DSRIP application.
b. Public comment period. The state must engage the public and all affected stakeholders (including community stakeholders, Medicaid beneficiaries, physician groups, hospitals, and health plans) by publishing the development of the DSRIP Program Funding and Mechanics Protocol and DSRIP Strategies Menu and Metrics (Attachments I and J), including all relevant background material, and providing a public comment period that will be no less than 30 days that includes submission of comments through electronic means as well as public meetings across the State.
c. Allowable changes to DSRIP protocols. The state must post the public comments received and any technical modifications the state makes to the DSRIP Program Funding and Mechanics Protocol and DSRIP Strategies Menu and Metrics (Attachments I and J).Only changes to the protocol and menu that are related to the public comments will be allowed and incorporated into final protocols for DY 1 to DY 5. The state will submit the final protocols and menu and CMS will review and take action on the changes (ie. approve, deny or request further information or modification) no later than 30 days after the state’s submission.
d. Baseline data on DSRIP measures. The state must use existing data accumulated prior to implementation to identify performance goals for performing providers. The state must identify high performance levels for all anticipated measures in order to ensure that providers select projects that can have the most meaningful impact on the Medicaid population, and may not select projects for which they are already high performers, with the exception of projects specifically focused on avoidable hospitalization.
e. Procurement of entities to assist in the administration and evaluation of DSRIP. The state will identify independent entities with expertise in delivery system improvement, including an independent assessor, an independent evaluator and any other an administrative costs. The independent entities will work in cooperation with one another to do the following:
i. Independent Assessor: Conduct a transparent review of all proposed DSRIP project plans and make project approval recommendations to the state.
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ii. Independent Evaluator: Assist with the continuous quality improvement activities. iii. Administrative Costs: Administrative costs the state incurs associated with the
management of DSRIP reports and other data.
A. The state must describe the functions of each independent entity and their relationship with the state as part of its Operational Protocol (Attachment K)
B. The state may elect to require IGTs to be used to fund the non-federal share of the administrative activities, as permitted under the state plan.
C. Spending on the independent entities and other administrative cost associated within the DSRIP fund is classified as a state administrative activity of operating the state plan as affected by this demonstration. The state must ensure that all administrative costs for the independent entities are proper and efficient for the administration of the DSRIP Fund.
f. Submit evaluation plan. The state must submit an evaluation plan for DSRIP consistent with the requirements of STC 19 of this section no later than 120 days after award of the DSRIP program and must identify an independent evaluator. The evaluation plan, including the budget and adequacy of approach to meet the scale and rigor of the requirements of STC 21 of this section, is subject to CMS approval.
g. Update comprehensive quality strategy. The state must update its comprehensive quality strategy, defined in Section VI, to ensure the investment in DSRIP programs will complement and be supported by the state’s managed care quality activities and other quality improvements in the state, including the state’s Medicaid Redesign Team and Health Homes initiatives.
h. DSRIP Operational Protocol. The state shall submit for CMS approval a draft operational protocol for approving, overseeing, and evaluating DSRIP project grants no later than 90 days after the award of the Demonstration. The protocol is subject to CMS approval. The State shall provide the final protocol within 30 days of receipt of CMS comments. If CMS finds that the final protocol adequately accommodates its comments, then CMS will approve the final protocol within 30 days. This protocol will become an appendix to Attachment K of these STCs.
i. The Operational Protocol, including required baseline and ongoing data reporting, independent assessor protocols, performing provider requirements, and monitoring/evaluation criteria shall align with the CMS approved evaluation design and the monitoring requirements in STC 34 of this section.
ii. The state shall make the necessary arrangements to assure that the data needed from the Performing Provider Systems, and data needed from other sources, are available as required by the CMS approved monitoring protocol.
iii. The Operational Protocol and reports shall be posted on the state Medicaid website within 30 days of CMS approval.
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i. CMS Oversight of Pre-implementation Activities. CMS reserves the right to provide oversight over the state’s pre-implementation activities in order to document late submissions and missed deliverables without notice of a delay from the state. Notice of delay from of any deliverable must be received by CMS no less than 10 days before the due date of the deliverable. As part of CMS’ review of the state’s deliverables, CMS will assess completeness based on listed deliverable requirements in the STCs.
11. DSRIP proposal and project plan review. In accordance with the schedule outlined inthese STCs and the process described further in the Program Funding and Mechanics Protocol (Attachment I), the state and the assigned independent assessor must review and approve DSRIP project plans in order to authorize DSRIP funding for DY 1, DY 2, and DY 3 and must conduct ongoing reviews of DSRIP project plans as part of a mid-point assessment in order to authorize DSRIP funding for DY 4 and DY 5. The state is responsible for conducting these reviews for compliance with approved protocols. CMS reserves the right to review projects in which the state did not accept the finding of the independent assessor or other outlier projects, as specified in the Program Funding and Mechanics Protocol(Attachment I).
a. Review tool. The state will develop a standardized review tool that the independent assessor will use to review DSRIP project plans and ensure compliance with these STCs and associated protocols. The review tool will be available for public comment for a 30 day period according to the timeframe specified in the Program Funding and Mechanics Protocol (Attachment I). The review tool will define the relevant factors, assign weights to each factor, and include a scoring for each factor. Each factor will address the anticipated impact of the project on the Medicaid and uninsured populations consistent with the overall purpose of the DSRIP program.
b. Role of the Independent assessor. An independent assessor will review project proposals using the state’s review tool and consider anticipated project performance. The independent assessor shall make recommendations to the state regarding approvals, denials or recommended changes to project plans to make them approvable. This entity (or another entity identified by the state) will also assist with the mid-point assessment and any other ongoing reviews of DSRIP project plan.
c. Public comment. Project proposals will be public documents and subject to public comment. The public will have no less than30 days from the date of project posting to submit comments for specific project proposals, according to the process described in the Operational Protocol (Attachment K). After the comment period for the projects closes, a method for which the public can continue to comment must remain available, to obtain feedback on the ongoing implementation of the projects. The state must periodically compile comments received over the life of the demonstration and ensure that responses to comments are provided and released for public view.
d. Mid-point assessment. During DY 3, the state’s independent assessor shall assess project performance to determine whether DSRIP project plans merit continued funding and
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provide recommendations to the state. If the state decides to discontinue specific projects, the project funds may be made available for expanding successful project plans in DY 4 and DY 5, as described in the Program Funding and Mechanics Protocol(Attachment I).
12. Monitoring. With the assistance of the independent assessor, the state will be actively involved in ongoing monitoring of DSRIP projects, including but not limited to the following activities.
a. Review of milestone achievement. At least two times per year, Performing Provider Systems seeking payment under the DSRIP program shall submit reports to the state demonstrating progress on each of their projects as measured by project-specific milestones and metrics achieved during the reporting period. The reports shall be submitted using the standardized reporting form approved by the state and CMS. Based on the reports, the state will calculate the incentive payments for the progress achieved according to the approved DSRIP project plan. The Performing Provider System shall have available for review by New York or CMS, upon request, all supporting data and back-up documentation. These reports will serve as the basis for authorizing incentive payments to Performing Provider Systems for achievement of DSRIP milestones.
b. Quarterly DSRIP Operational Protocol Report. The state shall provide quarterly updates to CMS and the public on the operation of the DSRIP program. The reports shall provide sufficient information for CMS to understand implementation progress of the demonstration and whether there has been progress toward the goals of the demonstration. The reports will document key operational and other challenges, to what they attribute the challenges and how the challenges are being addressed, as well as key achievements and to what conditions and efforts they attribute the successes.
c. Learning collaboratives. With funding available through this demonstration, the state will support regular learning collaboratives regionally and at the state level, which will be a required activity for all Performing Provider Systems, and may be organized either geographically, by the goals of the DSRIP, or by the specific DSRIP projects as described in the DSRIP Strategies Menu and Metrics (Attachment J). Learning collaboratives are forums for Performing Provider Systems to share best practices and get assistance with implementing their DSRIP projects. Learning collaboratives should primarily be focused on learning (through exchange of ideas at the front lines) rather than teaching (i.e. large conferences), but the state should organize at least one face-to-face statewide collaborative meeting a year. Learning collaboratives should be supported by a web site to help providers share ideas and simple data over time (which should not need to be developed from scratch). In addition, the collaboratives should be supported by individuals (regional “innovator agents”) with training in quality improvement who can travel from site to site in the network to rapidly answer practical questions about implementation and harvest good ideas and practices that they systematically spread to others.
d. Rapid cycle evaluation. In addition to the comprehensive evaluation of DSRIP described
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in STC 22 of this section, the state will be responsible for compiling data on DSRIP performance after each milestone reporting period and summarizing DSRIP performance to-date for CMS in its quarterly reports. Summaries of DSRIP performance must also be made available to the public on the state’s website along with a mechanism for the public to provide comments.
e. Additional progress milestones for at risk projects. Based on the information contained in the Performing Provider System’s semiannual report or other monitoring and evaluation information collected, the state or CMS may identify particular projects as being “at risk” of not successfully completing its DSRIP project in a manner that will result in meaningful delivery system transformation. The state or CMS may require these projects to meet additional progress milestones in order to receive DSRIP funding in a subsequent semi-annual reporting period. Projects that remain “at risk” are likely to be discontinued at the midpoint assessment, described in STC 11 of this section.
f. Annual discussion and site visits. In addition to regular monitoring calls, the State shall on an annual basis present to and participate in a discussion with CMS on implementation progress of the demonstration including progress toward the goals, and key challenges, achievements and lessons learned. The state, the independent assessor, and CMS will conduct annual site visits of a subset of Performing Providers to ensure continued compliance with DSRIP requirements.
g. Application, review, oversight, and monitoring database. The state will ensure that there is a well maintained and structured database, containing as data elements all parts and aspects of Performing Provider Systems’ DSRIP project plans including the elements discussed in paragraph 8; independent assessor, state, and CMS review comments and scores; project planning, process, improvement, outcome, and population health milestones, with indicators of their required timing, incentive payment valuation, and whether or not they were achieved; and any other data elements required for the oversight of DSRIP. Along with the database, the state will develop software applications that will support:
i. Electronic submission of project plans by Performing Provider Systems;
ii. Public comment on project plans;
iii. Review of project plans by the independent assessor, state, and other independent participants in project plan review and scoring;
iv. Electronic submission by Performing Provider Systems of their performance data;
v. Generation of reports, containing (at a minimum) the elements in STC 36 of this section, that can be submitted to CMS to document and support amounts claimed for DSRIP payments on the CMS-64;
vi. Summaries of DSRIP project plans submissions, scoring, approval/denial, milestone
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achievement, and payments that can be accessed by the public;
vii. Database queries, and export all or a portion of the data to Excel, SAS, or other software platforms; and
viii. On-line access rights for CMS.
13. Financial Requirements applying to DSRIP payments generally.
a. The non-Federal share of Fund payments to providers may be funded by state general revenue funds, and transfers from units of local government consistent with federal law.Any DSRIP payment must remain with the provider specified in the DSRIP project plan,and may not be transferred back to any unit of government, including public hospitals, either directly or indirectly. In the case of coalitions that are performing DSRIP projects collectively, the DSRIP funding will flow to the participating providers and/or the coalition coordinating entity according to the methodology specified in the DSRIP project plan but may not be transferred between coalition providers.
b. The state must inform CMS of the funding of all DSRIP payments to providers through a quarterly payment report to be submitted to CMS within 60 days after the end of each quarter, as required under STC 36 of this section. This report must identify the funding sources associated with each type of payment received by each provider. This report must identify and fully disclose all the underlying primary and secondary funding sources of the non-Federal share (including health care related taxes, intergovernmental transfers, general revenue appropriations, and any other mechanism) for each type of payment received by each provider.
c. The state will ensure that any lack of adequate funds from local sources will not result in lowering the amount, duration, scope or quality of Medicaid services available under the state plan or this demonstration. The preceding sentence is not intended to preclude the state from modifying the Medicaid benefit through the state plan amendment process.
d. The state may not claim FFP for DSRIP Payments until both the state and CMS have concluded that the performing providers have met the performance indicated for each payment. Performing providers’ reports must contain sufficient data and documentation to allow the state and CMS to determine if the performing provider has fully met the specified metric, and performing providers must have available for review by the state or CMS, upon request, all supporting data and back-up documentation. FFP will be available only for payments related to activities listed in an approved DSRIP project plan.
e. Each quarter the State makes DSRIP Payments or IAAF payments and claims FFP, appropriate supporting documentation will be made available for CMS to determine the appropriate amount of the payments. Supporting documentation may include, but is not limited to, summary electronic records containing all relevant data fields such as Payee, Program Name, Program ID, Amount, Payment Date, Liability Date, Warrant/Check Number, and Fund Source. Documentation regarding the Funds revenue source for
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payments will also identify all other funds transferred to such fund making the payment. This documentation should be used to support claims made for FFP for DSRIP Payments that are made on the CMS-64.9 Waiver forms.
f. DSRIP Payments are not direct reimbursement for expenditures or payments for services. Payments from the DSRIP Fund are intended to support and reward performing providers for improvements in their delivery systems that support the simultaneous pursuit of improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Payments from the DSRIP Fund are not considered patient care revenue, and shall not be offset against disproportionate share hospital expenditures or other Medicaid expenditures that are related to the cost of patient care (including stepped down costs of administration of such care) as defined under these Special Terms and Conditions, and/or under the State Plan.
14. Limits on Federal Financial Participation.
a. Use of FFP. The state will receive up to a total of $8 billion FFP to support MRT activities: $6.92 billion for DSRIP, $500 million of which will be for the IAAF, and the remaining amount to be allocated by the state for remaining MRT activities (with no more than $1.08 billion for such other activities).
b. MRT Cap. The State can claim FFP for MRT expenditures in each DSRIP Year up to the limits shown in the table below. Each DSRIP Project Plan must specify the DSRIP Year to which each milestone pertains; all incentive payments associated with meeting the milestone must count against the annual limit for the DSRIP Year identified. The state or its contractor shall monitor and report proper execution of project valuations and funds distribution as part of the implementation monitoring and reporting required under STC 35 of this section.
c. One-year DSRIP funding carry-over. If a performing provider system does not fully achieve a metric in Domains 2, 3 or 4 that was specified in its approved DSRIP project plan for completion in a particular DSRIP year, the performing provider system must report on the missed metrics in the given DSRIP year. Performing Provider Systems that do not meet annual milestones for a given metric will not be eligible to receive incentive payments for the missed metrics in that given DSRIP year. Any funding that would have been allocated to the performing provider system during that DSRIP year will be placed in the performance pool fund to be redistributed to Performing Provider Systems that have exceeded their set performance benchmarks for that DSRIP year. When a performing provider system does not meet its DSRIP year performance metrics, the missed metrics milestone will be recalibrated based on the procedures in DSRIP Program Funding and Mechanics Protocol (Attachment I) for the next DSRIP year and the performing provider system will be eligible to receive payments from the DSRIP payment pool for that next year if it reaches the recalibrated milestone in that next DSRIP year.
d. Fund Allocations According to MRT Demonstration Year
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($ millions)
Year-
0Year-1 Year-2 Year-3 Year-4 Year-5 Total
Sources of Funding
Public Hospital IGT Transfers (Supports DSRIP IGT Funding for Public Performing Provider Transformation Fund, Safety Net Performance Provider System Transformation Fund, DSRIP, State Plan and Managed Care Services)
$512.0 $878.1 $933.0 $1,481.8 $1,317.1 $878.1 $6,000.0
State Appropriated Funds $188.0 $345.4 $476.6 $467.8 $343.5 $178.7 $2,000.0
Total Sources of Funding $700.0 $1,223.5 $1,409.5 $1,949.6 $1,660.6 $1,056.8 $8,000.0
Uses of Funding
DSRIP Expenditures $620.0 $1,007.8 $1,070.7 $1,700.6 $1,511.6 $1,007.8 $6,918.5
Interim Access Assurance Fund (IAAF)
$500.0 $0.0 $0.0 $0.0 $0.0 $0.0 $500.0
Planning Payments $70.0 $0.0 $0.0 $0.0 $0.0 $0.0 $70.0
Performance Payments $0.0 $957.8 $1,020.7 $1,650.6 $1,461.6 $957.8 $6,048.5
Administration $50.0 $50.0 $50.0 $50.0 $50.0 $50.0 $300.0
Health Homes $80.0 $66.7 $43.9 $0.0 $0.0 $0.0 $190.6
MC Programming $0.0 $149.0 $294.9 $249.0 $149.0 $49.0 $890.9
Health Workforce MLTC Strategy
$0.0 $49.0 $49.0 $49.0 $49.0 $49.0 $245.0
1915i Services $0.0 $100.0 $245.9 $200.0 $100.0 $0.0 $645.9
Total Uses of Funding $700.0 $1,223.5 $1,409.5 $1,949.6 $1,660.6 $1,056.8 $8,000.0
*Includes costs associated with State based planning in Year-0.
*New York State may spend up to 5% of annual costs on Administration.
e. Notwithstanding the limits in STC 1.a and 14.a, to the extent that the state elects to limit supplemental payments to an institutional provider class otherwise authorized under its state plan in any state fiscal year during which the DSRIP demonstration is in effect, an amount equal to the federal share of the amount not paid to such providers, up to $600 million may be added to the overall MRT and DSRIP limits on federal funding. This election will be available only to the extent that the state does not increase the authorized levels of such supplemental payments, or initiate new supplemental payments, during the authorized demonstration period. The state must develop and use a tracking spreadsheet (following a format approved by CMS) to ensure that the amounts of the DSRIP increase
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do not exceed the amount of authorized but unpaid supplemental payments.
f. Statewide accountability. Beginning in DSRIP Year 3, the limits on DSHP funding and on total DSRIP payments described in paragraph (a) above may be reduced based on statewide performance, according to the process described in the Program Funding and Mechanics Protocol.
g. Statewide performance will be assessed on a pass or fail basis, for a set of 4 milestones.
i. Statewide performance on universal set of delivery system improvement metrics (asdefined in Attachment J). Metrics for delivery system reform will be determined at astatewide level. Each metric will be calculated to reflect the performance of the entire state. Each of these statewide metrics will be assigned a direction for improving and worsening. This milestone will be considered passed in any given year if more metrics in these domains are improving on a statewide level than are worsening, as compared to the prior year as well as compared to initial baseline performance.
ii. A composite measure of success of projects statewide on project-specific and population wide quality metrics. This test is intended to reflect the success of every project in achieving the goals that have been assigned to each project, including pay for reporting for certain outcome measures as specified in DSRIP Strategies Menu and Metrics (Attachment J). As described in DSRIP Program Funding and Mechanics Protocol (Attachment I), each metric that determines project level incentive payments for each project will be determined at the project level to be meeting the improvement standards. This statewide milestone will be considered passed in any given year if the number of metrics for each project that trigger award as the improvement standards in DSRIP Program Funding and Mechanics Protocol (Attachment I) are greater than the number of metrics for each project that fail to trigger an award as per the improvement standard in DSRIP Program Funding and Mechanics Protocol (Attachment I).
iii. Growth in statewide total Medicaid spending, including MRT spending, that is at or below the target trend rate (Measure applies in DY4 and DY5). The per member per month (PMPM) amounts will be adjusted to exclude growth in federal funding associated with the Affordable Care Act. The state will not be penalized if it uses these higher FMAP rates generated by the Affordable Care Act to reinvest in its Medicaid program.
Growth in statewide total inpatient and emergency room spending that is at or below the target trend rate (Measure applies in DY 3, DY 4 and DY 5).
Both of the above measures will be measured on a PMPM basis in the most recent state fiscal year from the state fiscal year that immediately precedes it, with applicable spending including both federal and non-federal shares combined. Per member per month spending in each measure is determined by dividing statewide total spending by the number of person-months of Medicaid eligibility in the state for
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the state fiscal year. The most recent state fiscal year is the last state fiscal year ending prior to the start of the DSRIP Year. For total Medicaid spending, the target trend rate is the ten-year average rate for the long-term medical component of the Consumer Price Index (as used to determine the state's Medicaid Global Spending Cap for that year), for DYs 4 and 5 only. For inpatient and emergency room spending the target trend rate is the ten-year average rate for the long-term medical component of the Consumer Price Index (as used to determine the state's Medicaid Global Spending Cap for that year) minus 1 percentage points for DY 3 and 2 percentage points for DYs 4 and 5.
iv. Implementation of the managed care plan, including targets agreed upon by CMS and the state after receipt of the managed care contracting plan in STC 39 of this section related to reimbursement of plans and providers consistent with DSRIP objectives and measures. These targets will include one associated with the degree to which plans move away from traditional fee for service payments to payment approaches rewarding value.
h. The state must pass all four milestones to avoid DSRIP reductions. If the state fails on any of the 4 milestones, the amount of the potential reduction is set as follows:
The state must pass 50 percent of the inpatient/emergency room spending reduction goals to avoid DSHP penalties. This will be the sole test for any DSHP penalty. The amount of the potential reduction is set as follows:
DSRIP Year 3 DSRIP Year 4 DSRIP Year 5
DSHP Penalty $23.39 million (5 percent)
$34.35 million (10 percent)
$35.74 million (20 percent)
DSRIP Penalty $74.09 million (5 percent)
$131.71 million (10 percent)
$175.62 million (20 percent)
If DSRIP and DSHP penalties are applied, the state reduce funds in an equal distribution of projects, and will not affect the high performance fund.
15. Designated State Health Programs (DSHP). The state may claim FFP for certain DSHP expenditures, following procedures and subject to limits as described below.
a. Limit on FFP for DSHP. The amount of FFP that the state may receive for DSHP may not exceed the limit described below. If upon review, the amount of FFP received by the state is found to have exceeded the applicable limit, the excess must be returned to CMS as a negative adjustment to claimed expenditures on the CMS-64.
$ millionsYear 0 Year 1 Year 2 Year 3 Year 4 Year 5 Total
188.0 345.4 476.6 467.8 343.5 178.7 2,000
The FFP limit for 2014 is the lowest of the following amounts:
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i. $188 million,
ii. The combined non-Federal share of IAAF Payments, DSRIP Project Design Grant payments and DSRIP administrative costs in 2014, and
iii. The federal share of total matchable DSHP expenditures in 2014 as outlined below.
b. DSHP List 1. The state may claim FFP in support of DSRIP for List 1 DSHP expenditures made after March 31, 2014. The state may not claim FFP until after the date on which CMS has approved a DSHP Claiming Protocol for the specific DSHP.
i. Health Care Reform Act programs
A. AIDS Drug AssistanceB. Tobacco Use Prevention and ControlC. Health Workforce Retraining
ii. State Office on Aging programsA. Community Services for the ElderlyB. Expanded In-Home Services to the Elderly
iii. Office of Children and Family Services: Committees on Special Education direct care programs
iv. State Department of Health, Early Intervention Program Services
c. DSHP List 2. The state may claim FFP in support of DSRIP for List 2 DSHP expenditures made after December 31, 2014. The state may not claim FFP until after the date
on which CMS has approved a DSHP Claiming Protocol for the specific DSHP
i. Homeless Health Services
ii. Childhood Lead Poisoning Primary Prevention
iii. Healthy Neighborhoods Program
iv. Cancer Services Programs
v. Obesity and Diabetes Programs
vi. TB Treatment, Detection and Prevention
vii. TB Directly Observed Therapy
viii. General Public Health Work
ix. Newborn Screening Programs
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d. DSHP List 3. The state may claim FFP in support of DSRIP for List 3 DSHP expenditures not used for DD Transformation. The state may not claim FFP until after the
date on which CMS has approved a DSHP Claiming Protocol for the specific DSHP
i. Office of Mental Health
A. Licensed Outpatient ProgramsB. Care ManagementC. Emergency ProgramsD. Rehabilitation ServicesE. Residential (Non-Treatment)F. Community Support Programs
ii. Office for People with Developmental Disabilities
A. Day TrainingB. Family Support ServicesC. Jervis ClinicD. Intermediate Care FacilitiesE. HCBS ResidentialF. Supported Work (SEMP)G. Day HabilitationH. Service Coordination/Plan of Care SupportI. Pre-vocational ServicesJ. Waiver RespiteK. Clinics - Article 16
iii. Office of Alcoholism and Substance Abuse Services
A. Outpatient and Methadone ProgramsB. Prevention and Program Support Services
e. DSHP Claiming Protocol. The state will develop a CMS-approved DSHP claiming protocol with which the state will be required to comply in order to draw down DSHP funds for DSRIP. State expenditures for the DSHP listed above must be documented in accordance with the protocols. The state is not eligible to receive FFP until an applicable protocol is approved by CMS. Once approved by CMS, the protocol becomes Attachment L of these STCs, and thereafter may be changed or updated with CMSapproval. Changes and updates are to be applied prospectively. For each DSHP, the protocol must contain the following information:
i. The sources of non-federal share revenue, full expenditures and rates.
ii. Program performance measures, baseline performance measure values, and improvement goals. (CMS may, at its option, approve the DSHP Claiming Protocol
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for a DSHP without this feature.)
iii. Procedures to ensure that FFP is not provided for any of the following types of expenditures:
A. Grant funding to test new models of careB. Construction costs (bricks and mortar)C. Room and board expendituresD. Animal shelters and vaccinesE. School based programs for childrenF. Unspecified projectsG. Debt relief and restructuringH. Costs to close facilitiesI. HIT/HIE expendituresJ. Services provided to undocumented individualsK. Sheltered workshopsL. Research expendituresM. Rent and utility subsidies normally funded by the United State Department of
Housing and Urban DevelopmentN. Prisons, correctional facilities, and services provided to individuals who are
civilly committed and unable to leaveO. Revolving capital fundP. Expenditures made to meet a maintenance of effort requirement for any federal
grant programQ. Administrative costsR. Cost of services for which payment was made by Medicaid or CHIP (including
from managed care plans)S. Cost of services for which payment was made by Medicare or Medicare
AdvantageT. Funds from other federal grants
f. DSHP Claiming Process.
i. Documentation of each designated state health program’s expenditures, as specified in the DSHP Protocol, must be clearly outlined in the state's supporting work papers and be made available to CMS.
ii. In order to assure CMS that Medicaid funds are used for allowable expenditures, the state will be required to document through an Accounting and Voucher system its request for DSHP payments. The vouchers will be detailed in the services being requested for payment by the state and will be attached to DSHP support.
iii. Federal funds must be claimed within two years following the calendar quarter in which the state disburses expenditures for the DSHP.
iv. Federal funds are not available expenditures disbursed before April 1, 2014, or for
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services rendered prior to April 1, 2014.
v. Federal funds are not available for expenditures disbursed after December 31, 2014, or for services rendered after December 31, 2014.
vi. Sources of non-federal funding must be compliant with section 1903(w) of the Act and applicable regulations. To the extent that federal funds from any federal programs are received for the DSHP listed above, they shall not be used as a source of non-federal share.
vii. The administrative costs associated with the DSHP listed above, and any others subsequently added by amendment to the demonstration, shall not be included in any way as demonstration and/or other Medicaid expenditures.
viii. Any changes to the DSHP listed above shall be considered an amendment to the demonstration and processed in accordance with STC 7 in Section III.
g. Reporting DSHP Payments. The state will report all expenditures for DSHP payments to the programs listed above on the forms CMS-64.9 Waiver and/or 64.9P Waiver under the waiver name “DSRIP DSHP” (if in support of DSRIP) or “IAAF DSHP” (if in support of Interim Access Assurance Fund payments) as well as on the appropriate forms CMS-64.9I and CMS-64PI.
16. Budget Neutrality Review. In conjunction with any demonstration renewal beyond December 31, 2014, CMS reserves the right to modify the budget neutrality agreement consistent with budget neutrality policy.
17. Improved Management Controls. The state and CMS agree that, in conjunction with any Partnership Plan demonstration renewal beyond December 31, 2014, the state will undertake additional activities and steps to strengthen internal controls, compliance with federal and state Medicaid requirements and financial reporting to ensure proper claiming of federal match for the Medicaid program, and to self-identify and initiate timely corrective action on problems and issues. To support the development of these additional special terms and conditions, the state will provide a report to CMS by October 1, 2014, outlining its assessment of current strengths and weaknesses of the state’s system of internal and financial management controls (taking into account any audit findings from federal or state oversight agencies including the HHS Office of Inspector General, the state Office of Inspector General, and CMS); the steps the state proposes to take to strengthen compliance, documentation and transparency; and the expected path for resolution of any outstanding deferrals or disallowances initiated by CMS as of the date of this amendment.
18. DSRIP Transparency. During the 30 day public comment period for the DSRIP Program Funding and Mechanics protocol (Attachment I), DSRIP Strategies Menu and Metrics (Attachment J), the state must have conducted at least two public hearings regarding the state's DSRIP amendment approval. The state must utilize teleconferencing or web capabilities for at least one of the public hearings to ensure statewide accessibility. The two public hearings must be held on separate dates and in separate locations, and must afford the
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public an opportunity to provide comments. Once the state develops its standardized review tool the independent assessor will use for the DSRIP project plans, the tool must also be posted for public comment for 30 days.
a. Administrative Record. CMS will maintain, and publish on its public Web site, an administrative record that may include, but is not limited to the following:
i. The demonstration application from the state.ii. Written public comments sent to the CMS and any CMS responses.
iii. If an application is approved, the final special terms and conditions, waivers, expenditure authorities, and award letter sent to the state.
iv. If an application is denied, the disapproval letter sent to the state.v. The state acceptance letter, as applicable.
vi. Specific requirements related to the approved and agreed upon terms and conditions, such as implementation reviews, evaluation design, quarterly progress reports, annual reports, and interim and/or final evaluation reports.
vii. Notice of the demonstration’s suspension or termination, if applicable.
b. CMS will provide sufficient documentation to address substantive issues relating to the approval documentation that should comprehensively set forth the basis, purpose, and conditions for the approved demonstration.
19. Submission of Draft Evaluation Design. The state shall submit a draft DSRIP evaluation design to CMS no later than 120 days after the award of the demonstration, including, but not limited to data that the state proposes to be used to evaluate DSRIP. The state must employ aggressive state-level standards that align with its managed care evaluation approach.
20. Submission of Final Evaluation Design. The state shall provide the Final Evaluation Design within 30 days of receipt of CMS comments of the Draft Evaluation Design. If CMS finds that the Final Evaluation Design adequately accommodates its comments, then CMS will approve the Final Evaluation Design and the final evaluation plan will be included as Attachment M of these STCs.
21. Evaluation Requirements. The state shall engage the public in the development of its evaluation design. The evaluation design shall incorporate an interim and summative evaluation and will discuss the following requirements as they pertain to each:
a. The scientific rigor of the analysis;b. A discussion of the goals, objectives and specific hypotheses that are to be tested;c. Specific performance and outcomes measures used to evaluate the demonstration’s
impact;d. How the analysis will support a determination of cost effectiveness;e. Data strategy including sources of data, sampling methodology, and how data will be
obtained;f. The unique contributions and interactions of other initiatives; and g. How the evaluation and reporting will develop and be maintained.
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The demonstration evaluation will meet the prevailing standards of scientific and academic rigor, as appropriate and feasible for each aspect of the evaluation, including standards for the evaluation design, conduct, and interpretation and reporting of findings. The demonstration evaluation will use the best available data; use controls and adjustments for and reporting of the limitations of data and their effects on results; and discuss the generalizability of results.
The state shall acquire an independent entity to conduct the evaluation. The evaluation design shall discuss the state’s process for obtaining an independent entity to conduct the evaluation, including a description of the qualifications the entity must possess, how the state will assure no conflict of interest, and a budget for evaluation activities.
22. Evaluation Design. The Evaluation Design shall include the following core components to be approved by CMS:
a. Research questions and hypotheses: This includes a statement of the specific research questions and testable hypotheses that address the goals of the demonstration, including:i. safety net system transformation at both the system and state level;
ii. accountability for reducing avoidable hospital use and improvements in other health an public health measures at both the system and state level and
iii. efforts to ensure sustainability of transformation of/in the managed care environment at the state level.
The research questions will be examined using appropriate comparison groups and studied in a time series.
b. The design will include a description of the quantitative and qualitative study design (e.g., cohort, controlled before-and-after studies, interrupted time series, case-control, etc.), including a rationale for the design selected. The discussion will include a proposed baseline and approach to comparison. The discussion will include approach to benchmarking, and should consider applicability of national and state standards. The application of sensitivity analyses as appropriate shall be considered.
c. Performance Measures: This includes identification, for each hypothesis, of quantitative and/or qualitative process and/or outcome measures that adequately assess the effectiveness of the Demonstration in terms of cost of services and total costs of care, change in delivery of care from inpatient to outpatient, quality improvement, and transformation of incentive arrangements under managed care. Nationally recognized measures should be used where appropriate. Measures will be clearly stated and described, with the numerator and dominator clearly defined. To the extent possible, the state will incorporate comparisons to national data and/or measure sets. A broad set of metrics will be selected. To the extent possible, metrics will be pulled from nationally recognized metrics such as from the National Quality Forum, Center for Medicare and Medicaid Innovation, meaningful use under HIT, and the Medicaid Core Adult sets, for which there is sufficient experience and
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baseline population data to make the metrics a meaningful evaluation of the New York Medicaid system.
d. Data Collection: This discussion shall include: A description of the data sources; the frequency and timing of data collection; and the method of data collection. The following shall be considered and included as appropriate:
i. Medicaid encounter and claims data in TMSIS, ii. Enrollment data,
iii. EHR data, where availableiv. Semiannual financial and other reporting datav. Managed care contracting data
vi. Consumer and provider surveys, andvii. Other data needed to support performance measurement
e. Assurances Needed to Obtain Data: The design report will discuss the state’s arrangements to assure needed data to support the evaluation design are available
f. Data Analysis: This includes a detailed discussion of the method of data evaluation,including appropriate statistical methods that will allow for the effects of the Demonstration to be isolated from other initiatives occurring in the state. The level of analysis may be at the beneficiary, provider, health plan and program level, as appropriate, and shall include population and intervention-specific stratifications, for further depth and to glean potential non-equivalent effects on different sub-groups. Sensitivity analyses shall be used when appropriate. Qualitative analysis methods shall also be described, if applicable.
g. Timeline: This includes a timeline for evaluation-related milestones, including those related to procurement of an outside contractor, if applicable, and deliverables.
h. Evaluator: This includes a discussion of the state’s process for obtaining an independent entity to conduct the evaluation, including a description of the qualifications that the selected entity must possess; how the state will assure no conflict of interest, and a budget for evaluation activities.
23. Interim Evaluation Report. The state is required to submit a draft Interim Evaluation Report 90 days following completion of DY 4 of the demonstration. The Interim Evaluation Report shall include the same core components as identified in STC 24 of this section for the Summative Evaluation Report and should be in accordance with the CMS approved evaluation design. CMS will provide comments within 60 days of receipt of the draft Interim Evaluation Report. The state shall submit the final Interim Evaluation Report within 30 days after receipt of CMS’ comments.
24. Summative Evaluation Report. The Summative Evaluation Report will include analysis of data from DY 5. The state is required to submit a preliminary summative report in 180 days of the expiration of the demonstration including documentation of outstanding
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assessments due to data lags to complete the summative evaluation. Within 360 days of the end for DY 5, the state shall submit a draft of the final summative evaluation report to CMS. CMS will provide comments on the draft within 60 days of draft receipt. The state should respond to comments and submit the Final Summative Evaluation Report within 30 days.
25. The Final Summative Evaluation Report shall include the following core components:
a. Executive Summary. This includes a concise summary of the goals of the Demonstration; the evaluation questions and hypotheses tested; and key findings including whether the evaluators find the demonstration to be budget neutral and cost effective, and policy implications.
b. Demonstration Description. This includes a description of the Demonstration programmatic goals and strategies, particularly how they relate to budget neutrality and cost effectiveness.
c. Study Design. This includes a discussion of the evaluation design employed including research questions and hypotheses; type of study design; impacted populations and stakeholders; data sources; and data collection; analysis techniques, including controls or adjustments for differences in comparison groups, controls for other interventions in the state and any sensitivity analyses, and limitations of the study.
d. Discussion of Findings and Conclusions. This includes a summary of the key findings and outcomes, particularly a discussion of cost effectiveness, as well as implementation successes, challenges, and lessons learned.
e. Policy Implications. This includes an interpretation of the conclusions; the impact of the demonstration within the health delivery system in the state; the implications for state and federal health policy; and the potential for successful demonstration strategies to be replicated in other state Medicaid programs.
f. Interactions with Other State Initiatives. This includes a discussion of this demonstration within an overall Medicaid context and long range planning, and includes interrelations of the demonstration with other aspects of the state’s Medicaid program, and interactions with other Medicaid waiver sand other federal awards affecting service delivery, health outcomes and the cost of care under Medicaid.
26. State Presentations for CMS. The state will present to and participate in a discussion with CMS on the final design plan at post approval. The state will present on its interim evaluation report that is described to in STC 23 of this section. The state will present on its summative evaluation in conjunction with STC 24 of this section.
27. Public Access. The state shall post the final approved Evaluation Design, Interim Evaluation Report, and Summative Evaluation Report on the State Medicaid website
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within 30 days of approval by CMS.
28. CMS Notification. For a period of 24 months following CMS approval of the Summative Evaluation Report, CMS will be notified prior to the public release or presentation of these reports and related journal articles, by the state, contractor or any other third party. Prior to release of these reports, articles and other documents, CMS will be provided a copy including press materials. CMS will be given 30 days to review and comment on journal articles before they are released. CMS may choose to decline some or all of these notifications and reviews.
29. Electronic Submission of Reports. The state shall submit all required plans and reports using the process stipulated by CMS, if applicable.
30. Cooperation with Federal Evaluators. Should CMS undertake an evaluation of the demonstration or any component of the demonstration, or an evaluation that is isolating the effects of DSRIP, the state and its evaluation contractor shall cooperate fully with CMS and its contractors. This includes, but is not limited to, submitting any required data to CMS or the contractor in a timely manner and at no cost to CMS or the contractor.
31. Cooperation with Federal Learning Collaboration Efforts. The state will cooperate with improvement and learning collaboration efforts by CMS.
32. Evaluation Budget. A budget for the evaluation shall be provided with the evaluation design. It will include the total estimated cost, as well as a breakdown of estimated staff, administrative and other costs for all aspects of the evaluation such as any survey and measurement development, quantitative and qualitative data collection and cleaning,analyses, and reports generation. A justification of the costs may be required by CMS if the estimates provided do not appear to sufficiently cover the costs of the design or if CMS finds that the design is not sufficiently developed.
33. Deferral for Failure to Provide Summative Evaluation Reports on Time. The state agrees that when draft and final Interim and Summative Evaluation Reports are due, CMS may issue deferrals in the amount of $5,000,000 if they are not submitted on time to CMS or are found by CMS not to be consistent with the evaluation design as approved by CMS.
34. DSRIP Implementation Monitoring. The state must ensure that they are operating its DSRIP program according to the requirements of the governing STCs. In order to demonstrate adequate implementation monitoring towards the completion of these requirements, the state will submit the following:
a. DSRIP monitoring activities, in STC 35 of this section as a part of the operational protocol in STC 10 (h) of this section indicating how the state will monitor compliance with demonstration requirements in the implementation of this demonstration, including monitoring and performance reporting templates. Monitoring and performance templates are subject to review and approval by CMS.
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b. Data usage agreements demonstrating the availability of required data to support the monitoring of implementation.
c. Quarterly Report Framework indicating what metrics and data will be available to submit a quarterly report consistent with STC 36 of this section.
35. DSRIP Monitoring Activities. As part of the state’s Operational Protocol described in STC 10 (h) of this section and Attachment K, the state will submit its plans for how it will meet the DSRIP STCs through internal monitoring activities. The monitoring plans should provide, at a minimum, the following information:
a. The monitoring activities aligned with the DSRIP deliverables as well as the CMS evaluation design to ensure that entities participating in the DSRIP process are accountable for the necessary product and results for the demonstration.
b. The state shall make the necessary arrangements to assure that the data needed from the performing providers, coalitions, administrative activities, independent assessor and independent evaluator that are involved in the process for DSRIP deliverables, measurement and reporting are available as required by the CMS approved monitoring protocol.
c. The state shall identify areas within the state’s internal DSRIP process where corrective action, or assessment of fiscal or non-fiscal penalties may be imposed for the entities described in STC 10(e) of this section, should the state’s internal DSRIP process or any CMS monitored process not be administered in accordance with state or federal guidelines.
d. The monitoring protocol and reports shall be posted on the state Medicaid website within 30 days of submission to CMS.
36. DSRIP Quarterly Progress Reports. The state must submit progress reports in the format specified by CMS, no later than 60-days following the end of each quarter along with the Operational Protocol Report described above. The first DSRIP quarterly reportswill be due by August 30, 2014. The intent of these reports is to present the state’s analysis and the status of the various operational areas in reaching the three goals of the DSRIP activities. These quarterly reports, using the quarterly report guideline outlined in Attachment L, must include, but are not limited to the following reporting elements:
a. Summary of quarterly expenditures related to IAAF, DSRIP Project Design Grant, and the DSRIP Fund;
b. Summary of all public engagement activities, including, but not limited to the activities required by CMS;
c. Summary of activities associated with the IAAF, DSRIP Project Design Grant, and the DSRIP Fund. This shall include, but is not limited to, reporting requirements inSTC 3 of this section and Attachment K, the Operational Protocol:
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i. Provide updates on state activities, such as changes to state policy and procedures, to support the administration of the IAAF, DSRIP Project Design Grant and the DSRIP Fund;
ii. Provide updates on provider progress towards the pre-defined set of activities and associated milestones that collectively aim towards addressing the state’s goals;
iii. Provide summary of state’s analysis of DSRIP Project Design; iv. Provide summary of state analysis of barriers and obstacles in meeting
milestones;v. Provide summary of activities that have been achieved through the DSRIP Fund;
and vi. Provide summary of transformation and clinical improvement milestones and that
have been achieved.
d. Summary of activities and/or outcomes that the state and MCOs have taken in the development of and subsequent approval of the Managed Care DSRIP plan; and
e. Evaluation activities and interim findings.
The state may comment and submit a revised Attachment L no later than 30 days after approval of these STCs. CMS will approve necessary changes and update the attachment as necessary. Any subsequent changes to Attachment L must be submitted to CMS prior the end of the reporting period in which the change to the Quarterly Report would take place.
37. Annual Onsite with CMS. In addition to regular monitoring calls, the state shall on an annual basis present to and participate in a discussion with CMS on implementation progress of the demonstration including progress toward the goals, and key challenges, achievements and lessons learned.
38. Rapid Cycle Assessments. The state shall specify for CMS approval a set of performance and outcome metrics and network characteristics, including their specifications, reporting cycles, level of reporting (e.g., the state, health plan and provider level, and segmentation by population) to support rapid cycle assessment in trends under premium assistance and Medicaid fee-for-service, and for monitoring and evaluation of the demonstration.
39. Medicaid Managed Care DSRIP Contracting Plan. In recognition that the DSRIP investments represented in this waiver must be recognized and supported by the state’s managed care plans as a core component of long term sustainability, and will over time improve the ability of plans to coordinate care and efficiently deliver high quality services to Medicaid beneficiaries through comprehensive payment reform, strengthened provider networks and care coordination, the state must take steps to plan for and reflect the impact of DSRIP in managed care contracts and rate-setting approaches. Prior to the state submitting contracts and rates for approval for the April 1, 2015 to March 31, 2016 contract cycle, the state must submit a roadmap for how they will amend contract terms and reflect new provider capacities and efficiencies in managed care rate-setting.
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Recognizing the need to formulate this plan to align with the stages of DSRIP, this should be a multi-year plan, and necessarily be flexible to properly reflect future DSRIP progress and accomplishments. This plan must be approved by CMS before the state may claim FFP for managed care contracts for the 2015 state fiscal year. The state shall update and submit the Managed Care DSRIP plan annually on the same cycle and with the same terms, until the end of this demonstration period and its next renewal period. Progress on the Managed Care DSRIP plan will also be included in the quarterly DSRIP report. The Managed Care DSRIP plan should address the following:
a. What approaches MCOs will use to reimburse providers to encourage practices consistent with DSRIP objectives and metrics, including how the state will plan and implement its stated goal of 90% of managed care payments to providers using value-based payment methodologies.
b. How and when plans’ currents contracts will be amended to include the collection and reporting of DSRIP objectives and measures.
c. How the DSRIP objectives and measures will impact the administrative load for MCOs, particularly insofar as plans are providing additional technical assistance and support to providers in support of DSRIP goals, or themselves carrying out programs or activities for workforce development or expansion of provider capacity. The state should also discuss how these efforts, to the extent carried out by plans, avoid duplication with DSRIP funding or other state funding; and how they differ from any services or administrative functions already accounted for in capitation rates.
d. How alternative payment systems deployed by MCOs will reward performance consistent with DSRIP objectives and measures.
e. How the state will assure that providers participating in and demonstrating successful performance through DSRIP will be included in provider networks.
f. How managed care rates will reflect changes in case mix, utilization, cost of care and enrollee health made possible by DSRIP, including how up to date data on these matters will be incorporated into capitation rate development.
g. How actuarially-sound rates will be developed, taking into account any specific expectations or tasks associated with DSRIP that the plans will undertake, and how the state will use benchmark measures (e.g., MLR) to ensure that payments are sound and appropriate. How plans will be measured based on utilization and quality in a manner consistent with DSRIP objectives and measures, including incorporating DSRIP objectives into their annual utilization and quality management plans submitted for state review and approval by January 31 of each calendar year.
h. How the state will use DSRIP measures and objectives in their contracting strategy approach for managed care plans, including reform.
40. New York MRT-DSRIP Deliverables Schedule.
Due Date/Submission Date Activity/Deliverable
April 14, 2014CMS approves STCs and DSRIP Attachments
New York posts the DSRIP Funding and Mechanics Protocol and the DSRIP
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Strategies Menu and Metrics for public comment for 30 days
New York posts IAAF Qualifications and Application on for public comment for 14 days;
14 day IAAF application period begins once comment period closes
IAAF awards can be distributed after 14 day application period closes
State has 10 days to submit its first report for IAAF payments (STC 1(b)(iii)(A) of this section)
State will make baseline data for DSRIP measures available
State submits its proposed independent assess statement of work (SOW) for its independent assessor contract procurement
May 1, 2014
State must accept DSRIP STCs or offer technical corrections, including for the DSRIP Operational Protocol and the Quarterly Reporting formats
State has 10 days to submit changes to the DSRIP Funding and Mechanics Protocol and the DSRIP Strategies Menu and Metrics once public comment period closes
CMS will review changes to the DSRIP Funding and Mechanics Protocol and DSRIP Strategies Menu and Metrics and take action no later than 30 days after state submits changes
State accepts DSRIP Design Grant applications and make Design Grant awards
State posts DSRIP Project Plan Review Tool that independent assessor will use to score submitted DSRIP Project Plan applications for 30 days
August 1, 2014 State submits draft DSRIP evaluation design
August 30, 2014
State submits its first quarterly report, including its operational report (STCs 35 & 36)
October 1, 2014State submits its Improved Management Controls report to CMS
State accepts DSRIP Project Plan applications
State will perform initial review of submitted DSRIP Project Plan applications
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Independent assessor will perform full review of DSRIP project plan applications
Independent assessor will post reviewed DSRIP Project Plan applications for public comment for 30 days
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Independent assessor approval recommendations made public
State Distributes DSRIP Project Plan awards for approved performing provider systems
Quarterly Deliverables – Quarterly Report and Operational Report
August 30, 2014
November 30, 2014
February 28, 2015
May 30, 2015*Note: Activities/Deliverables without a specific Due Date/Submission Date could occur at any time during the timeframes with dates certain, for example the public comment period for the DSRIP Funding and Mechanics Protocol could occur any time after April 14, 2014, based on the state’s discretion, so long as the activities are completed and related deliverables are submitted. Should the state renew the demonstration, the quarterly reporting will continue during the renewal period.
IX. GENERAL REPORTING REQUIREMENTS
1. General Financial Requirements. The state must comply with all general financial requirements set forth in Section X.
2. Reporting Requirements Related to Budget Neutrality. The state must comply with all reporting requirements for monitoring budget neutrality set forth in section XI.
3. Monthly Calls. CMS shall schedule monthly conference calls with the state. The purpose of these calls is to discuss any significant actual or anticipated developments affecting the demonstration. Areas to be addressed include, but are not limited to, MCO operations (such as contract amendments and rate certifications), transition and implementation activities, health care delivery, the FHP-PAP program, enrollment of individuals using LTSS and non-LTSS users broken out by duals and non-duals, cost sharing, quality of care, access, family planning issues, benefits, audits, lawsuits, financial reporting and budget neutrality issues, MCO financial performance that is relevant to the demonstration, progress on evaluations, state legislative developments, services being added to the MMMC and/or MLTC plan benefit package pursuant to Section V, and any demonstration amendments, concept papers, or state plan amendments the state is considering submitting. CMS shall update the state on any amendments or concept papers under review, as well as federal policies and issues that may affect any aspect of the demonstration. The state and CMS shall jointly develop the agenda for the calls.
4. Quarterly Operational Reports. The state must submit progress reports in accordance with the guidelines in Attachment D taking into consideration the requirements in STC 7 of this section, no later than 60 days following the end of each quarter (December, March, and June
