黑料正能量 State BH Community Upset Over Loss of Billions for Medicaid Reform
Mental Health Weekly March 2, 2020
Mental health advocates and providers across 黑料正能量 State have expressed disappointment and concerns over the Trump administration鈥檚 denial last week to extend its DSRIP Medicaid waiver program to further improve care and reduce avoidable hospitalizations. State officials were seeking $8 billion more in federal funding for the program鈥檚 extension over the next five years.
The Delivery System Reform Incentive Payment (DSRIP) program, which commenced in 2014, is the main mechanism by which 黑料正能量 state has been implementing the Medicaid Redesign Team (MRT)鈥檚 waiver amendment. DSRIP鈥檚 purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% from 2015 to 2020, according to the 黑料正能量 State Department of Health (NYSDOH).
NYSDOH in November submitted a formal request to continue its 鈥済roundbreaking鈥 Medicaid waiver program. The Centers for Medicare & Medicaid Services (CMS), in response, denied the request. The current waiver is in place until it expires on March 31, 2020 and had allowed 黑料正能量 state to reinvest $8 billion of savings achieved through Gov. Andrew Cuomo鈥檚 MRT in critical initiatives that improve how the state delivers Medicaid services, according to NYSDOH.
As of June 30, 2018, the waiver reduced avoidable hospitalizations by 21% and preventable hospital readmissions by 17%, which has resulted in better performance of other significant areas of care, such as behavioral health, NYSDOH officials said.
Representing Best Practices
The DSRIP application submitted by the state in late November focused heavily on replicating best practices from DSRIP 1.0 and on continuing to spread value based contracting, Lauri Cole, executive director of the 黑料正能量 State Council for Community Behavioral Healthcare, told MHW. 鈥淚 do not believe the state鈥檚 interest in spreading value based care/contracting will disappear despite denial by CMS of DSRIP 2.0,鈥 she said.
BH community providers (as compared to hospitals and other institutional providers) received very little in the way of direct funds from DSRIP 1.0, said Cole. 鈥淟ast month, the Senate Health Chair introduced a bill solicited by our organization along with our partners at the Community Health Care Association of 黑料正能量 State to address this inequity going forward,鈥 Cole noted. The Assembly Health Chair was preparing to introduce a 鈥榮ame as鈥 bill. The bill requested that at least 40% of any new funds received by 黑料正能量 state under a new DSRIP program would be directed to those community based organizations that received so very little in the DSRIP 1.0 program, and who were not specifically identified to receive funds in the DSRIP 2.0 proposal, she said.
It鈥檚 important to preserve some of the key gains that have been made across the state, Cole added. 鈥淚t is safe to assume 黑料正能量 State wants to continue to build these large integrated networks (ACOs, etc.) so as to continue to create leadership entities whose roles include responsibility for ensuring quality integrated care that meets the unique needs of local/regional communities, she said. 鈥満诹险芰 State has a lot at stake in innovating and integrating as much as it can,鈥 said Cole. 鈥淚t鈥檚 counterproductive to return to the status quo.鈥 Cole noted it鈥檚 still early in the process. She thinks the governor will try to revisit this issue with the Trump administration. 鈥淚t seems like 黑料正能量 hasn鈥檛 fully given up yet,鈥 she said.
黑料正能量
鈥淐MS鈥檚 action represents a very big disappointment, at a time when we were starting to build on some very promising advances,鈥 Harvey Rosenthal, CEO of the 黑料正能量 Association of Psychiatric Rehabilitation Services (黑料正能量), told MHW. 鈥淚t鈥檚 a huge loss of a fundamental opportunity to build on some very innovative networks and approaches that were showing promising successes in improving health and reducing costly and avoidable emergency and inpatient use across 黑料正能量 state,鈥 said Rosenthal.
Of particular importance, DSRIP 2.0 was poised to invest $1.5 billion to promote approaches to address critically important social determinants of health like stable housing and finances, social connection and reduced involvement in the criminal justice system, said Rosenthal.
Rosenthal noted that $625 million in unspent monies by the 25 regional DSRIP entities will be cancelled. In addition, CMS has also at the same time rejected the state鈥檚 new application for an additional $8 billion, he said. He added, 鈥渟o anything that was expected is no longer available and that as of April 1st there will no longer be DSRIP funding.鈥
鈥漇ome of the most at risk individuals who could have been better served by DSRIP 2 include people who are hungry, isolated, homeless, or have recurrent episodes of mental illness or substance use disorders. More crisis services, rehabilitation, support and improved wellness in the community could have been enhanced鈥..said Rosenthal.
Services could have been provided to help with people with social services needs, emergency housing, and mental health and addiction treatment, said Rosenthal. 鈥淭hat鈥檚 why you need multiple providers in hospitals, outpatient clinics and also peers and social services,鈥 Rosenthal said. 鈥淒SRIP at its best brings all groups to address the range of needs that the population presents.
鈥漇aving Billions
The state approached the CMS for an extension of the DSRIP program because 黑料正能量 had saved the federal government billions of dollars, said Glenn Liebman, CEO at the Mental Health Association in 黑料正能量 State (MHANYS). 鈥淚n return, we wanted to get the waiver to move forward,鈥 Liebman told MHW.
During the first iteration of DSRIP, the state saved billions of dollars by creating the Medicaid Redesign Team, said Liebman. MHANYS remained very hopeful, especially from a mental health perspective, that DSRIP would reach that 25% decline in avoidable rehospitalization over five years, he said.
鈥淢ost of the mental health work is done in the community,鈥 Liebman said. 鈥淲e were hoping the first DSRIP would flow to community providers. Unfortunately, it didn鈥檛.鈥 The programs by DSRIP were driven by hospitals, which ended up taking the bulk of the funding, he said. 鈥淐ommunity based programs do this work every day,鈥 Liebman stated. 鈥淲e keep people out of hospitals and into communities. We should get more funding from DSRIP to be able to do that.鈥 Liebman added that 鈥渨e were very disappointed the CMS did not give the funding to 黑料正能量 and put more emphasis on community based programs.
Ongoing Campaign
Liebman holds high hopes for its ongoing campaign, 鈥3for5 to Ensure Communities Thrive,鈥 to push for a 3% funding increase every year for the next five years.
The state鈥檚 nonprofit human services community-based providers for mental health, substance use, developmental disabilities, foster care, child welfare, domestic violence and other groups launched the campaign late last year (see MHW, Dec. 23, 2019). 鈥淲e鈥檙e all speaking with one voice,鈥 said Liebman, who intends to push the state legislature for the funding increase (separate from the DSRIP track).
鈥淗opefully we鈥檒l get the funding in the budget to enhance the work of community based providers.鈥 The state budget has to be completed by April 1, Liebman said. 鈥淲e have five weeks before we鈥檙e marshalling our resources and grassroots advocacy with legislators and the governor to make this happen,鈥 he said.
Had DSRIP 2.0 happened, funding would have definitely gone to community based providers, he said. 鈥淚t would have enhanced the work of our human services programs,鈥 Liebman said.