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LeadingAge NY Urges Investment in Long-Term/Post-Acute Care for DSRIP 2

As they strive to serve a growing and medically complex population of older adults, New York's long-term/post-acute care (LTPAC) and senior services providers are seeking support under the second phase of the State's Delivery System Reform Incentive Payment (DSRIP) Program. LeadingAge NY offered its recommendations for the second phase in a recent letter to Donna Frescatore, New York State's Medicaid Director. LeadingAge NY pointed to underfunding of LTPAC under the first phase of DSRIP and called for investment in LTPAC infrastructure, senior housing with services, workforce, and rural providers in the second phase. The first phase – a five-year program which will sunset in March 2020 – provides for investment of $6.2 billion in transforming the State's health care delivery system to improve quality and outcomes while reducing overall cost. Under the program, the State is required to reduce avoidable hospital use by 25 percent. It is also required to meet specified targets for value-based payment (VBP) penetration under Medicaid managed care.

Frescatore and Greg Allen, Director of Program Development and Management in the Department of Health (DOH), highlighted some of the successes of DSRIP and themes for the next phase in presentations at the United Hospital Fund's recent Medicaid conference. Allen noted, for example, that Potentially Preventable Admissions have declined by 21 percent over four years. Frescatore indicated that 63 percent of managed care payments to providers are in VBP arrangements, and 25 percent are in arrangements that involve both upside and downside risk. Allen said that the next phase of DSRIP will focus on:

  • Supporting promising practices;
  • Collaborations among managed care plans, providers, and community-based organizations under VBP;
  • Flexibility in the structure and governance of performing provider systems (PPSs);
  • Alignment of PPS performance with other initiatives; and
  • Expanding promising practices to additional children.

The State has released a timeline for its application for renewal of the DSRIP program, with a draft concept paper to be circulated for comments this summer and submission of the application to the Centers for Medicare and Medicaid Services (CMS) by Sept. 30, 2019.

In anticipation of the release of the DSRIP Phase 2 concept paper, LeadingAge NY urged the Department to use the second phase to invest in LTPAC infrastructure and in the expansion of the LTPAC workforce. We also pressed the Department to address the unique challenges facing rural providers of LTPAC. In addition, we supported Medicare and Medicaid alignment as a strategy to improve outcomes and efficiency and highlighted managed long term care (MLTC) plans sponsored by non-profit long term care (LTC) providers as key players in strengthening these initiatives. Finally, we pointed to housing with services as a strategy to address social determinants of health among low-income older adults and recommended that the next phase include funding for resident assistants in affordable senior housing developments.

LeadingAge NY will continue to provide updates as more details concerning DSRIP Phase 2 emerge.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124