DSRIP 2.0 Draft Amendment Includes Long-Term Care Elements
The Department of Health (DOH) released a draft proposed amendment of its 1115 Medicaid Waiver and Delivery System Reform Incentive Payment (DSRIP) Program on Sept. 17th. The draft amendment seeks $8 billion to be invested over four years as follows: $5 billion in DSRIP Performance, $1 billion in Workforce Development, $1.5 billion in Social Determinants of Health (SDH), and $500 million in the Interim Access Assurance Fund.
DOH responded to LeadingAge NY's advocacy by highlighting long-term care reform as one of three "Additional High-Need Priority Areas" in the draft amendment. It acknowledges that "certain high-need and high-cost populations such as higher-risk children and members needing long-term care did not benefit directly from most DSRIP initiatives unless a Medicaid-measured avoidable hospitalization could be impacted such as ER visits for childhood asthma." The draft amendment suggests further exploration of bundling and value-based payment (VBP) options for long-term care and recognizes the workforce crisis in long-term care. It promotes the continuation of Performing Provider System (PPS) workforce collaborations to identify reforms needed to support the aging population and to address workforce needs. The amendment incorporates some of the workforce development initiatives advanced by LeadingAge NY, including subsidies and stipends for participating in aide certification and nursing programs; loan forgiveness programs for nursing graduates; and subsidies for work barrier removal, including child care for licensed practical nurses (LPNs) and aides. It notes that workforce needs are "particularly acute in rural areas and will require innovative approaches."
The draft amendment proposes the creation of two new types of provider networks: “Value-Driving Entities” (VDEs) and “Social Determinant of Health Networks” (SDHNs). Each VDE will "consist of PPS (or a subset of PPS), provider, community-based organization (CBO) and managed care organization (MCO) teams specifically approved by the state to implement the high-priority DSRIP promising practices." VDEs will continue to be assigned specific regions and attributed populations but will have the flexibility to either modify the existing PPS structure to accommodate additional representation or propose new alignments. All VDEs will be required to bring managed care plans "into the management and operational structure to replicate and scale (and make ready for VBP contracting) the promising practices." The amendment notes that "the infrastructure of primary, pre-acute, post-acute, in-home, behavioral health, and long-term care collaborations formed in the DSRIP program will serve as the foundation and will be expanded and more fully leveraged by the VDE."
SDHNs will deliver "socially focused interventions linked to VBP." Lead entities will be selected through a competitive procurement, with VDEs and PPSs being eligible applicants:
The lead entity of the SDHN will create a network of CBOs that will collectively use evidence-based interventions to coordinate and address housing, nutrition, transportation, interpersonal safety and toxic stress. The state would designate regions and pick a lead applicant in each region to 1) formally organize CBOs to perform SDH interventions; 2) coordinate a regional referral network with multiple CBOs and health systems; 3) create a single point of contracting for VBP SDH arrangements; and 4) assess Medicaid Members for the key State-selected SDH issues and make appropriate referrals based on need.
The proposed waiver amendment will continue the $500 million Interim Access Assurance Fund investment to provide supplemental payments to safety net hospitals to ensure that they can fully participate in the DSRIP transformation without disruption.
LeadingAge NY will comment on the proposed waiver amendment and continue its advocacy to promote an equitable investment of DSRIP funding in the long-term/post-acute care (LTPAC) sector and its workforce. Comments may be submitted to DOH by Nov. 4th here. LeadingAge NY members are encouraged to submit their comments to LeadingAge NY here, as well as to DOH.
Contact: Karen Lipson, firstname.lastname@example.org, 518-867-8838