Equity Programs (EP) Monthly Update Webinar
- Webinar also available in Portable Document Format (PDF, 190KB)
August 2016
Today´s Agenda
- EP Webinar Information
- EP Primary Contacts
- EP FAQs
- EP Contracts
- EPP DY1 Results
- EPP DY1 Payments
- EPP Measure Diversification
- EIP Activity Selection Update
- EIP Underpayment Update
- EIP Attestation in DY2
- IT TOM Update
- MAX Update
- Next Steps and Q&A
- Open Forum
EP General Updates
Registering for Monthly Webinars
- EP Monthly Update Webinars are scheduled to occur on the fourth Wednesday of each month at 1:00 pm.
- Participants must register for each webinar separately.
- The Department of Health (DOH) sends a registration e-mail to EP participants a week prior to the scheduled webinar announcing the webinar information and registration instructions.
- Participants who do not register before the scheduled date may experience difficulty joining the webinar.
- Next EP Webinar to be held on Wednesday, September 28th at 1:00 pm.
Equity Programs Primary Contacts List
- To allow for easier and more efficient communications, DOH is requesting that all participants send in two EP primary contacts to dsrip_ssp@health.ny.gov.
- The primary contacts´ information should include both contacts´ names, titles, organizations, phone numbers, and email addresses.
- DOH will share the complete list of EP primary contacts to all program participants once the list is updated.
- Please send this information by as soon as possible, as primary contacts will be used by DOH for all Equity Programs communications going forwards.
- DOH is still awaiting responses, and will post whatever has been submitted by Friday, September 9th to the webpage.
EP Frequently Asked Questions (FAQs)
- DOH has updated the EP FAQs to include questions from the July EP Monthly Update Webinar.
- The updated FAQs document can be found on the EP webpage.
- DOH will no longer be distributing a copy of the updated FAQs to participants as the most recent version will now be placed at the webpage above.
EP Contracts
- DOH is in the process of gathering all EP contracts and is coordinating with the IA to document the four EIP activities and six EPP measures chosen by each MCO/PPS partnership in their submitted contracts.
- DOH urges the MCOs that have not submitted their contracts to send them, as EIP and EPP payments cannot be effectuated until EP contracts have been submitted.
- Contracts should be submitted via email to both dsrip_ssp@health.ny.gov and dsrip_ia@pcgus.com with "Equity Programs Contract" and the MCO´s and PPS´ name in the subject line.
- MCOs are expected to copy PPS partners when submitting their contracts to DOH and the IA, to keep all parties informed.
- Contracts that were not submitted by the July 29th, 2016 deadline may experience a delay in EPP payments.
- Contracts that are not submitted by September 30th, 2016 deadline will forfeit corresponding EIP and/or EPP payment for DY1 and DY2.
- Below is a list of all missing EP contracts, EPP measures, and EIP activities as of August 24th.
| MCO | Missing Contracts | Contract Received, but Missing Lists |
|---|---|---|
| Affinity | • ACP contract • Mount Sinai contract |
• The New York and Presbyterian Hospital EPP and EIP List |
| American Group | • The New York and Presbyterian Hospital contract | • Maimonides Medical Center EIP list • Mount Sinai EPP list • The New York-Presbyterian / Queens EPP and EIP list |
| Fidelis | • The New York and Presbyterian Hospital contract • The New York-Presbyterian / Queens contract |
• NYU Lutheran Medical Center EPP list • Mount Sinai contract EPP list |
| Health Insurance Plan | • Mount Sinai EPP list | |
| Healthfirst | • Mount Sinai contract • The New York and Presbyterian Hospital contract • The New York-Presbyterian / Queens contract |
|
| IHA | • Millennium Collaborative Care contract • Sisters of Charity Hospital of Buffalo contract |
|
| Metroplus | • The New York-Presbyterian / Queens contract | • Bronx-Lebanon Hospital Center EPP list • Maimonides Medical Center EPP and EIP list • Mount Sinai EPP list |
| United Health Plan | • The New York-Presbyterian / Queens Contract | • Mount Sinai EPP list |
| Health Insurance Plan | • The New York-Presbyterian / Queens EPP list |
EPP Updates
EPP DY1 Results
- MCOs that have submitted their select EPP DY1 measures by July 29th, 2016 can expect EPP DY1 performance results from the IA by Friday, September 16th.
- EPP measures are Pay for Reporting in DY1, but payment from the MCO to the PPS cannot be effectuated until the IA receives an EP contract for each MCO/PPS pairing.
- The achievement/ non-achievement of all partnered PPS´ chosen EPP metrics will be clearly displayed in the IA´s report to each MCO.
- MCOs will be notified by the IA via email and PPS will be cc´d (so long as primary contact information has been submitted).
- Going Forward, DY2-DY5 EPP performance results will be made available in the Q4 IA reports in July.
EPP DY1 Payments
- Similar to Equity Infrastructure Program (EIP) payments in 2015, EPP payments to MCOs have been delayed, due to the delay in the approval of the April 2016 rates.
- EPP payments cannot be made to PPS until MCOs receive EPP payments later this year, which will be retroactive to April 2016.
| Milestone | Due Date |
|---|---|
| MCOs submit EP contracts to DOH & IA | July 29, 2016 |
| DOH reviews EPP DY1 performance | August 2016 |
| IA releases EPP DY1 performance results to MCOs (PPS will be cc´d) | September 2016 |
| MCOs receive EPP payment retroactive to April 2016 | Oct. - Dec. 2016 |
- As a reminder, for contracts or measures/activities that are not submitted by September 30th, 2016 deadline, the affected PPS will forfeit all corresponding EIP or EPP payments for DY1 and DY2.
EPP Measure Selection/Diversification
- PPS have asked for the opportunity to diversify their risk of not achieving EPP measures by choosing different EPP measures with each of their MCO partners.
- For this one time exception, PPS may alter their EPP measures. The newly selected measures will be in place for the remainder of EPP (DY2-DY5).
- By September 30th, MCO-PPS partnerships must submit their amended EP contract containing the revised EPP measures to the IA
- If no measures are sent or revised EPP measures are sent after the due date, the new measures will not be accepted and DY1 EPP measures will remain in place.
- EPP measure changes can only be done through formal contract amendment. The changes must be agreed to by both the PPS and MCO, then submitted to DOH (dsrip_ssp@health.ny.gov) and the IA (dsrip_ia@pcgus.com).
- MCO/PPS partners will not be allowed to make any further EPP measures changes to their contracts after September 30th, 2016.
EIP Updates
EIP Activity Selection Guidance
- EIP Activities (unlike EPP measures) can be changed at the beginning of each program year.
- EIP Activities can only changed between years, not within years.
- EIP Activity changes can only be done through formal contract amendment submitted before April 1st of a given program year.
- For example, if a PPS seeks to change its EIP Activities between DY2 and DY3, an amended contract including the new Activities must be submitted prior to April 1st, 2017.
- Like any other contract amendment, EIP Activity changes must be agreed to by both the PPS and MCO, then submitted to DOH (dsrip_ssp@health.ny.gov) and the IA (dsrip_ia@pcgus.com).
EIP DY1 Underpayment Update
- In DY1 of EIP, there were instances where a PPS received less than the full annual amount that was allocated to it from at least one of its paired MCOs.
- DOH is actively working with CMS on a set of January 2016 EIP rate adjustments, which will close the gap between actual DY1 EIP payments and expected DY1 EIP payments.
- EIP rate adjustments are still pending CMS approval and have not yet been loaded - DOH will notify all affected MCOs and PPS once the adjustments are approved.
EIP Attestation and Evidence in DY2
- DOH determined that if MCOs and PPS agreed in their contracts that PPS attestation was sufficient as evidence of EIP activity, then the MCO could forward Program payment on that basis in DY1 only.
- This was due to a delay in EIP´s implementation in DY1.
- The PPS must have the documentation for any evidence they attested to on file.
- As a reminder, from DY2 onwards attestation is considered insufficient. Actual evidence of activity participation is required for the MCO to forward program payment to the PPS.
Information Technology Target Operating Model (IT TOM) Update
- Although the formal series of IT TOM workshops ended in DY2 Q1, PPS can continue to participate in IT TOM as one of their four selected EIP Activities
- Beginning in DY2 Q2, PPS can continue IT TOM in EIP in one of two ways (participation in either is sufficient):
- Conducting their own IT TOM workshop program, or
- Leveraging past IT TOM workshops
- DOH has developed a list of evidence PPS can provide to their paired MCOs as proof of continued IT TOM Activity (this list is not exhaustive):
- IT TOM Workshop Presentations
- IT TOM Workshop Meeting Minutes
- IT TOM Workshop Attendance Register
- Current and Target State Operating Models
- Updated Capability Model
- Updated Context Model
- List of High-level Use Cases
- Finalized BRD (Business Requirement Definition) and SRS (System Requirements Specification) Reports
- Finalized Requirements Traceability Matrices (RTMs)
- Guidance on IT TOM in EIP will be posted to the EP webpage on Friday, September 9th.
- As with other EIP activities, it is ultimately up to the MCO/PPS pairing to determine what counts as sufficient evidence for this activity in their contract.
Medicaid Accelerated Exchange (MAX) Update
- The formal MAX Series of workshops has been extended through DY2 (ends in June 2017), so it may continue to be selected as an EIP Activity for this year.
- Beyond the formal workshops, DOH is introducing the Train the Trainer (TTT) MAX series, which will involve training participants to host their own MAX workshops.
- MAX TTT recruitment begins in September 2016, with the workshops then beginning in January 2017.
- MAX TTT will enable PPS to continue to select MAX as an EIP Activity throughout the duration of DSRIP.
- More detailed information regarding the MAX Series will be coming in September´s Learning Symposium.
EIP Demonstration Year (DY2) Q2 Reporting
- DY2 Q2 ends September 30th, 2016. If PPS elected to report quarterly or semiannually, reports for the period should be sent to the listed entity at the appropriate e-mail address noted below:
| Report | Completed by | Submitted to | Frequency | Location |
|---|---|---|---|---|
| EP Contracts | PPS & MCO | IA & DOH | Annually | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EP Frequency Table | MCO | IA & DOH | Annually | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EIP Activity Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EIP Payment Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EPP Payment Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| PPS EIP Activity Table | PPS | MCOs | Based on EP Contracts | MCO contact emails |
| Supporting Documentation for EIP Activity participation |
PPS | MCOs | Based on EP Contracts | MCO contact emails |
| Supporting Documentation for EIP Activity participation |
MCO (reviewed by MCO after being sent by PPS) | IA | Based on EP Contracts | dsrip_ia@pcgus.com |
Next Steps and Q&A
- Please submit your finalized contracts to DOH and the IA as soon as possible.
- Contracts should be submitted via email to dsrip_ssp@health.ny.gov and dsrip_ia@pcgus.com with "Equity Programs Contract" and the MCO´s and PPS´ name in the subject line.
- Be sure to copy your PPS partner in the e-mail submission to DOH and the IA.
- Please send in two EP primary contacts to dsrip_ssp@health.ny.gov.
- The primary contacts´ information should include both contacts´ names, titles, organizations, phone numbers, and email addresses.
- Primary contact information will be posted to the EP webpage on Friday, September 9th.
- We will now hold a Q&A session.
Open Forum
- The next EP Monthly Update Webinar is scheduled for Wednesday, September 28th from 1:00 pm - 2:00 pm.
- The remainder of this webinar is reserved for an open forum session to raise any concerns or leading practices to the EP participants and DOH.
Thank you for your continued support with EP!
For any further questions, please contact the Supplemental Programs inbox: DSRIP_SSP@health.ny.gov
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