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Feds Deny Plan For DSRIP 2.0, Ending Program That Brought Billions of Dollars to NY
By Jonathan LaMantia  Crain’s Health Pulse  February 25, 2020

����������’s health care industry won’t be getting a DSRIP 2.0.

Gov. Andrew Cuomo said Monday that the Trump administration had denied ����������’s request to extend the Delivery System Reform Incentive Payment Program in two phases. Instead, it is set to end at the end of March as scheduled.

Under ����������’s application, the state would have extended the waiver in two phases. The first phase would have extended the waiver through March 2021 and allowed the state to use $625 million in unspent funds from its original $7.4 billion program. The second phase, stretching into March 2024, sought a $8 billion more in federal funding.

The Centers for Medicare and Medicaid Services denied both requests.

Kenneth Raske, president of the Greater ���������� Hospital Association, called CMS’ decision “extremely shortsighted” and said it “is a major step backward for ����������’s health care providers and the patients they serve.”

The decision is a turning point for the state’s health care industry. ���������� kicked off DSRIP in 2014 by devising a way to distribute $7.4 billion to transform the delivery system and reduce avoidable hospital use by 25% over five years.

The state Department of Health said in September that the 25 Performing Provider Systems were on track to reach that goal and had lowered preventable hospital admissions by 21% as of June 2018.

Critics of the program, however, have said the state’s health care system looks largely the same as it did five years ago because most of the DSRIP money went to hospitals and not community-based organizations.

“The current DSRIP waiver has been an important tool in the state’s efforts to transition away from the fee-for-service payment system, which emphasizes volume over value,” Eric Linzer, president and CEO of the state Health Plan Association, said in a statement. “The proposed amendment would have helped to further those efforts.”

Local health officials had expected it to be an uphill battle for ���������� state to persuade the Trump administration to give it billions in Medicaid waiver money.

Given the verdict, Performing Provider Systems must decide whether they will continue to operate without federal support. (Performing Provider Systems are a regional network of providers that have formed partnerships and collaborate in a DSRIP Project Plan aimed at improving health outcomes while reducing avoidable hospital readmissions: ����������).

Somos Community Care, the Suffolk Care Collaborative and other groups already have disclosed layoffs to the state Department of Labor.

Joseph Conte, executive director of the Staten Island PPS, said he was surprised that CMS isn’t allowing ���������� to extend its DSRIP program by one year and use its $625 million in unspent funds.

“I think there was a general expectation that the extension would go forward and the [$8 billion] renewal would be a complicated piece of business,” he said.

The Staten Island PPS plans to continue operating after April 1, generating revenue by offering consulting services to health plans and community-based organizations in the areas of data analytics, the social determinants of health and workforce development.

The organization has 14 employees right now, Conte said, down from 22.

“We have been working for the past two years for this day,” he said.

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Cuomo: Feds Are Playing Politics By Denying Health Care Funding Renewal
N.Y. lawmakers blame Trump for stripping $625M by denying Medicaid Delivery System Reform Incentive Payment waiver extension
By Amanda Fries and Cayla Harris Albany Times Union  Feb. 24, 2020

ALBANY – Gov. Andrew M. Cuomo accused the federal government Monday of playing politics with ����������ers’ health care after the state was told it would no longer receive federal funds for community-based health services.

The five-year, $8 billion federal funding stream has aided health care providers that improved service delivery and reduced emergency room visits. But Cuomo said federal officials have stripped the state of an extra $625 million through the initiative after denying ���������� a one-year extension on the state’s Medicaid Delivery System Reform Incentive Payment (DSRIP) waiver, which is set to expire March 31.

“If there’s one area that you’d think should be beyond politics, it’s health care,” Cuomo said during a news conference Monday at the Capitol. “And what the federal government is doing is hurting Democrats and Republicans, it’s not whether you’re blue or you’re red.”

State officials also had sought to extend the program for an additional $7.4 billion, three-year agreement, a request that was also denied.

It is the latest in a series of “federal horribles” against ����������, Cuomo claimed, accusing the Trump administration of repeatedly targeting the Empire State for its blue voting record. He pointed to both the federal government’s denial of assistance for Halloween flooding in upstate ���������� and the state’s recent scuffle with the president over expedited travel programs, as the Trump administration suddenly announced earlier this month that it would ban ����������ers from participating in certain trusted travel initiatives.

The federal government has pinned the blame on ����������, citing the state’s so-called Green Light Law, which both offers driver’s licenses to undocumented immigrants and blocks federal immigration officers from accessing motor vehicle records.

But federal officials said they are only honoring the original DSRIP agreement from 2014 that expires March 31.

In a letter to state officials on Friday, CMS Deputy Administrator and Director Calder Lynch noted that the award was “time-limited” and designed to be a one-time investment in “system transformation that [could] be sustained through ongoing reimbursement mechanisms and/or state and local initiatives.”

“CMS intends to maintain that agreement and preserve the original expiration of DSRIP’s expenditure authority as outlined in the (Medicaid Redesign Team) demonstration’s current terms and conditions,” Lynch wrote.

While the elimination of the $625 million in health care funds directly impacts providers, not the state’s budget, it comes at a time when ���������� is grappling with a $6.1 billion budget gap largely fueled by rising costs in Medicaid and the state’s decision to defer payments. Cuomo has tasked a second iteration of the Medicaid Redesign Team to find $2.5 billion in Medicaid savings.

Cuomo promised to work with ����������’s congressional delegation to revisit the decision on DSRIP. Democratic Sens. Kirsten Gillibrand and Charles E. Schumer both assailed the Trump administration for declining to renew the waiver, saying the move would hurt innocent ����������ers who rely on government-regulated health care.

U.S. Rep. Paul Tonko, D-Amsterdam, echoed Cuomo’s allegations of political power play, calling the federal government’s decision to end the waiver “the latest in a spate of politically motivated attacks on our state.”

“These policies have caused lasting damage to the working men and women [President Donald Trump] claims to champion,” Tonko said in a statement. “I will work side by side with Governor Cuomo and the entire ���������� delegation to fight for the restoration of these vital Medicaid funds.”

Bill Hammond, director of health policy for the Empire Center, a fiscally conservative think tank based in Albany, said neither state officials nor health care providers should have relied on future federal funding of DSRIP.

“They knew the money was running out and they should have planned on that,” he said.

CMS Administrator Seema Verma late last year had cautioned Medicaid directors that the federal government would no longer provide “open-ended, one-off DSRIP waivers.”

“We must move forward with a more unified, cohesive approach – across payers, across CMS, and across states,” Verma said during a speech for the National Association of Medicaid Directors in Washington, D.C. “Doctors on the front lines need payers to march in lock step together towards common value based care models to increase provider adoption.”

Ten states, including ����������, New Jersey, Texas and Kansas, benefit from the program payments.

Greater ���������� Hospital Association President Kenneth E. Rask called the CMS decision not to extend the funding a “major step backwards.”

Rask said the program improved care delivery, reduced preventable hospital admissions and readmissions and achieved savings for the federal government.

“This terrible decision will severely harm numerous DSRIP focus areas, including expanding medication-assisted treatment into primary care and emergency room settings, targeting seriously mentally ill populations for enhanced supports, and addressing housing and other social determinants of health,” Rask said in an emailed statement. “We must not let this happen. The health care of all ����������ers is much too important.”

Emilie Munson contributed reporting.