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���������� Note: The article below is just one example of many speculations in media reports this week about the distribution of 1115 waiver money. As DOH are finalizing the terms and conditions of the waiver behind closed doors with CMS this week, the rhetoric and seemingly inaccurate reporting in many areas only fuels confusion about how the DSRIP is going to work. For example, the article below indicates that HHC would request a certain amount of money from the reinvestment funds. Based on federal requirements, though, DSRIP funds will be allocated based on the strength of the projects proposed by hospitals and newly formed provider networks; the amount of savings that those projects might capture will determine the amount of money they are given to do the job. If the networks do not meet performance standards, they will recoup a lesser proportion of the money than originally contracted. We look forward to learning more from DOH as the terms are finalized so that we can help our community and members prepare for this change; until then, we can expect the media to take more opportunities for speculation.

HHC’s Waiver Funds in Question

Crain’s NY Business; 3/14/2014

The city’s Health and Hospitals Corp. is asking for $2 billion in federal Medicaid waiver funds over five years, HHC President Alan Aviles told the City Council Health Committee yesterday. Mr. Aviles said that HHC “should receive a percentage of the funding allocated to the public sector that is consistent with its Medicaid footprint.” HHC is responsible for more than three quarters of all Medicaid services to uninsured patients provided by the state, he said. The mayor’s preliminary budget assumes that HHC would receive half the amount it’s requesting. But even those projections are “far from certain,” from the Independent Budget Office found, in part because waiver funds, like all federal Medicaid funds, need a one-to-one match, and the amount of money HHC would be allowed to use for this is “very small.” And, as both the IBO and Mr. Aviles said, much waiver funding will depend on hospitals changing the way they operate and meeting certain metrics—meaning funds would be distributed after hospitals make significant investments on their own. The IBO noted that HHC has a history of performing worse than other city hospitals on certain metrics. Because the funding is performance based, however, “there is an opportunity for a reassignment of dollars after initial allocation,” Mr. Aviles said.

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