Delivery System Reform Incentive Payment (DSRIP) Program Mid-Point Assessment Overview

  • Presentation also available in Portable Document Format (PDF, 310KB)

All-PPS Meeting
February 17, 2016

Mid-Point Assessment Overview

  • The Mid-Point Assessment is a required component of the New York Delivery System Reform Incentive Payment (DSRIP) Program.
    • It is defined in Section VIII.11.d of the Standard Terms and Condition (STCs) of the 1115 waiver.
    • The requirements of the Mid-Point Assessment are further defined in Section VI.d of Attachment I to the STCs.
  • The Mid-Point Assessment is intended to provide a review of PPS progress towards the implementation of the approved DSRIP Project Plans for compliance with the program requirements identified in the STCs and to determine any modifications necessary to ensure PPS success through the remaining years of the program.
  • The requirements of the Mid-Point Assessment include an assessment of:
    • Compliance with the approved DSRIP Project Plan;
    • Compliance with the required core components for DSRIP projects described in the DSRIP Strategies Menu and Metrics;
    • Non-duplication of Federal funds;
    • Analysis and summary of relevant data on performance on metrics and indicators to this point in time;
    • The benefit of the project to the Medicaid and uninsured population and to the health outcomes of all patients served by the project;
    • Project governance including recommendations for how governance can be improved to ensure success;
    • The opportunity to continue to improve the project by applying any lessons learned or best practices that can increase the likelihood of the project advancing the three part aim; and
    • Current financial viability of all lead providers participating on the DSRIP project.

Mid-Point Assessment Timelines

  Date
PPS Completes DY2, Q1 Quarterly Report July 31, 2016
Independent Assessor begins reviews of DY2, Q1 Quarterly Report and Initiates Mid-Point Assessment August 1, 2016
Independent Assessor finalizes results of DY2, Q1 Quarterly Report September 29, 2016
Independent Assessor finalizes initial Mid-Point Assessment recommendations October 28, 2016
Independent Assessor recommendations released for PPS and public comment October 31, 2016
PPS response and public comment period ends December 1, 2016
Mid-Point Assessment recommendations released for 30 day public comment period December 15, 2016
Mid-Point Assessment 30 day public comment period ends January 15, 2017
Project Approval and Oversight Panel convenes to review Mid-Point Assessment recommendations; includes 1 day of public comment January 17 – 20, 2017
Project Approval and Oversight Panel recommendations submitted to Commissioner of Health January 24, 2017
Commissioner of Health submits recommendations to CMS January 31, 2017
PPS complete modifications to DSRIP Project Plans March 31, 2017

Mid-Point Assessment Process

  • The Independent Assessor will be responsible for conducting the Mid-Point Assessment and will rely on the following key data sources:
    • Approved DSRIP Project Plans
    • PPS Quarterly Reports - DY1, Q1 through DY2, Q1
      • The PPS activity through DY2, Q1 will serve as the basis for the Independent Assessor's Mid-Point Assessment review to ensure that all Mid-Point Assessment tasks are completed prior to the start of DY3.
      • PPS will be able to use the progress demonstrated through the DY2, Q2 PPS Quarterly Report to support responses to the Independent Assessor's recommendations or the PPS recommendations.
    • Claims and non-claims data for P4R/P4P measures
    • PPS Lead Financial Stability Test (to be submitted by the PPS lead, requirements consistent with DSRIP Project Plan Application)
  • The Independent Assessor will review the PPS project plan for overall compliance and each individual project being pursued by the PPS to assess likelihood of project success.
    • The assessment of individual projects will focus on AVs earned to date and PPS progress towards required project milestones through DY2, Q1 with focus on milestones that cross multiple projects.
      • Examples include PCMH Level 3 certification and the implementation and use of EHRs to share data and track patient engagement across the PPS.
  • The Independent Assessor will develop recommendations based on the Mid-Point Assessment reviews.
    • The Independent Assessor's recommendations will be released to the PPS and the public for a 30 day comment period.
    • The PPS will be able to submit responses to the Assessor's recommendations during this comment period.
    • The PPS will also be able to submit additional recommendations to the Independent Assessor during this period.
  • The Independent Assessor will develop recommendations based on the Mid-Point Assessment reviews that may include, but are not limited to, the following:
    • Continuation of PPS Project Plan;
    • Modifications to the approved project plans, such as a change in a project or projects selected for implementation by a PPS;
    • Changes to the PPS Lead entity;
    • Consolidations of multiple PPS in to a single PPS;
    • Discontinuation of a PPS' Project Plan;
    • Other remediation or improvements to increase the likelihood of PPS project success
    • Adding new providers to PPS network to assist in meeting PPS performance goals; or
    • Replication of best practices of other PPS.
  • Final Mid-Point Assessment recommendations, inclusive of Independent Assessor and PPS recommendations, will be submitted to DOH and released for a final 30 day public comment period.
  • The final Mid-Point Assessment recommendations will be subject to review by the Project Approval and Oversight Panel.
  • The Panel session will also include a day of public comment.
  • The recommendations from the Panel will be submitted to the Commissioner of Health with the Commissioner´s recommendations submitted to CMS.
  • PPS will be expected to implement any project plan modifications as recommended through the Mid-Point Assessment by March 31, 2017.

Mid-Point Assessment Network Modifications

  • In addition to the Mid-Point Assessment review process conducted by the Independent Assessor, the PPS will have the ability to assess their provider networks.
  • PPS will be able to request the removal of network partners at the Mid-Point Assessment.
    • Partner removals cannot exceed 5% of the total PPS network.
    • PPS must have documented cause for the removal of any network partners.
  • PPS can also seek an assessment of the Safety Net status for any network partners that are not currently Safety Net providers.
    • The Safety Net determination process will follow the Safety Net appeals process and will rely on more recent data to make the determination of Safety Net status.

IA e-mail:

DSRIP_IA@pcgus.com