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DSRIP Supplemental Programs

Carlos Cuevas
Senior Policy Advisor
Office of Health Insurance Programs
New York State Department of Health

Relating Demonstration Years, Payments, Quarterly Reporting Periods and Measurement Years

DOH has received Contract Status Surveys from all 15 PPS participating in EP:
- The majority of PPS anticipate contracts being signed by late April to early May.
- Most of the PPS have or will have one contract that covers both EIP and EPP.
- DOH has spoken with PPS that are experiencing contracting issues and is continuing communication in order to ensure that the contracts are executed.

DOH recently released recommendations for EIP measures that should be accompanied by financial substantiation.
- While most activities do not warrant financial proof of investment, ultimately, the discretion will be left to the PPS and the MCOs.
  1. The document is only to provide guidance and recommendations to the MCOs and PPS.
  2. The requirements should be determined when the PPS and MCOs negotiate their contracts.
For the metrics that do warrant financial proof of investment, DOH understands and expects that there will be variance between EIP funds paid to the PPS and PPS expenses towards those EIP activities - a dollar-to-dollar match is not expected.
- However, "meaningful investment" is expected to be shown.

DOH released updated EP FAQs on Wednesday, March 30th.
Highlights include:
- Clarification that for the MAX Series EIP activity, a PPS must participate in the formal MAX Series trainings for DYs 1 & 2, but DOH is exploring possibility of extending MAX Series initiatives in DYs 3-5
- Determination that EPP measures must remain the same throughout the program, except in two instances:
  1. A PPS that chooses a reporting based measure with an unknown baseline that results in a denominator less than 30, the measure may be changed at the start of DY2
  2. If DOH finds there is an issue with low denominators putting EPP measurement at risk, it reserves the right to change EPP measurement selections during the midpoint assessment.
- Clarification that if a denominator of a single measure falls below 30, that sixth of the EPP money is not forfeited by the PPS, but instead distributed among the remaining five measures increasing their respective rates.
- Determination that a care management system does not count as an Electronic Health Record (eHR) system for the EIP eHR implementation measure.
DOH expects that an updated EP FAQ Document will be distributed to EP participants on a monthly basis going forward.

Department of Health