DSRIP Project Design Grant Application

  • Webinar is also available in Portable Document Format

May 2014

John W. Gahan Jr., Director
Ben Babendreier
Haseeb Agha
Bureau of Vital Access Provider Reimbursement
Office of Health Insurance Programs

OBJECTIVES OF WEBINAR

  1. Introduction and Background for DSRIP Design Grant
  2. Process and Timeline
  3. How to complete the forms
  4. Submission of forms
  5. Questions and Answers

FIVE KEY THEMES OF DSRIP

  1. Collaboration, Collaboration, Collaboration!!!
  2. Project Value → what drives $
    1. Transformation → # and types of projects
    2. # of Medicaid members served (attribution)
    3. Application Quality
  3. Performance Based Payments
  4. Statewide Performance Matters
  5. Lasting Change
    1. Long–Term Transformation
    2. Health System Sustainability

SAFETY NET DEFINITION (HOSPITALS)

  • A hospital must meet one of the three following criteria to participate in a performing provider system:
    1. Must be either a public hospital, Critical Access Hospital or Sole Community Hospital,
      OR …
    2. Must pass two tests:
      1. At least 35 percent of all patient volume in their outpatient lines of business must be associated with Medicaid, uninsured and Dual Eligible individuals.
      2. At least 30 percent of inpatient treatment must be associated with Medicaid, uninsured and Dual Eligible individuals;
        OR …
    3. 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.

SAFETY NET DEFINITION (NON–HOSPITAL BASED PROVIDERS & NON–QUALIFYING DSRIP PROVIDERS)

  • 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 and must be associated with Medicaid, uninsured and Dual Eligible individuals.
  • Non–qualifying providers, can participate in Performing Providers Systems. However, no more than 5 percent of a project´s total valuation may be paid to non–qualifying providers. This 5 percent limit applies to non–qualifying providers as a group. CMS can approve payments above this amount if it is deemed in the best interest of Medicaid members attributed to the Performing Provider System.

SAFETY NET DEFINITION
(VITAL ACCESS PROVIDER EXCEPTION)

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:

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

DSRIP DESIGN GRANT OVERVIEW

  • Funds are to be used to support development of emerging Performing Provider Systems (PPSs)
  • Develop specific and comprehensive DSRIP Project Plans:
    • Community Needs Assessment
    • Stakeholder Engagement
    • Planning of specific projects
  • Awards will be split over two equal payments
    • Second payment conditional on deliverables (to be announced)
  • All PPSs who receive DSRIP Design Grant must prepare and submit a DSRIP Project Plan due December 16, 2014.

PROCESS AND TIMELINE

Item Explanation Dates
Application posted to DSRIP Website Excel and Instructions May 1, 2014
Applications Due Sent to BVAPR@health.state.ny.us June 17, 2014
Applications Review Applications reviewed for completeness June 18–30, 2014
Planning Grants Awarded List of Planning grants July 15, 2014
Initial Payment of Planning Grant 50% of Award July 30, 2014
Final Payment of Planning Grant 50% of Award September 15, 2014
(Tentatively Scheduled)

APPLICATION FORM OVERVIEW

  1. Application due 6/17/2014 – no extensions
  2. Non–binding Letter of Intent due 5/15/2014
  3. Separate tabs developed for the various sections
  4. Please read all instructions for application to be clear on expectations of each section
  5. File has many drop–down menus for ease of completion, please utilize as designed
  6. Space in text areas limited in number of characters allowed to focus responses to questions to high and summary type level information.
  7. Refer to DSRIP webpage for the Special Terms and Conditions (STC"s) and Attachments I and J for specific details
  8. File format for submission must be Excel
  9. No additional documentation will be accepted outside of the application form for submission.

COMPLETING THE APPLICATION

After carefully reading the instructions, if you still have questions, please send them to BVAPR@health.state.ny.us with the subject line “DSRIP – Facility Name”

Important Details:

  • Fill out all information in grey shaded areas – Cell turns white after information has been entered
  • Certain sections allow you to adjust and insert rows
  • Certain Cells have formatting restrictions –
    • Cells with drop down menus
    • Data type only (Numbers/No Text)

APPLICATION DEMO

http://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

QUESTIONS AND ANSWERS

We want to hear from you!

DSRIP website:
www.health.ny.gov/dsrip

DSRIP e–mail:
dsrip@health.state.ny.us

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Subscribe to our listserv:
http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm

*Please refer Project Design Grant questions to BVAPR@health.state.ny.us