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Basic Benefit: Evidence Based-Dossier Submission Process

Evidence-Based Dossier Submission Process

Upon taking office in January 2011, Governor Andrew M. Cuomo established the Medicaid Redesign Team (MRT) by executive order. The intent behind the MRT is to bring together experts and stakeholders from throughout the State to work cooperatively to reform the Medicaid system and reduce costs.

In Phase II of the redesign process, ten work groups were established to address more complex issues and monitor the implementation of key recommendations from Phase I. In an effort to ensure that New York Medicaid has an evidence informed benefit package which promotes high quality, efficient, and effective services that improve health and health care outcomes for its members, the Basic Benefit Review Work Group was established.

The Basic Benefit Review Work Group recognized that to prioritize treating all Medicaid patients equitably, and to make the most efficient use of finite public resources, they needed to create mechanisms for the responsible use of empirical evidence regarding the benefits, harms, and costs of Medicaid benefits and services in making redesign decisions. The work group established a transparent, systematic process for individuals to submit evidence to support requests for service coverage and to provide evidence to be considered in the Department's review of new and existing services.

Evidence-Based Policy Review

As an essential component of the New York Medicaid Redesign Team's (MRT) reforms, New York State is committed to structuring the Medicaid benefit to ensure that all members have access to the clinically effective, efficiently delivered services they require. To that end, the New York State Department of Health established a systematic process for making decisions about Medicaid benefits using the best available research evidence. The Dossier Process is designed to support transparent and consistent coverage and payment decisions that align with the Centers for Medicare and Medicaid Services' Triple Aim vision for health care of achieving better health, better quality, and lower costs.

Dossier Submission Process

Through the Dossier Process, the Department evaluates available evidence to determine coverage of health services, including new and existing procedures and devices. Covered services must be FDA approved when required, and supported by evidence of safety and effectiveness. Services of uncertain value (e.g., high cost with lower cost alternative; high risk; questionable efficacy) will be selected to go through the Dossier Process. Individuals or entities may submit an evidence dossier. Dossiers should be comprehensive, and include the most current research available. This dossier submission process will help the State better understand the body of clinical research evidence related to the service under review, what limitations on use may be appropriate, and whether coverage of the service represents significant value to the people of New York State. There will be a thirty day period after a dossier has been reviewed in which additional sources of evidence may be submitted to the department prior to a final coverage determination.

Prioritization of the selection of topics for review is at the discretion of the Department of Health. In addition, the Department of Health, at its discretion, reserves the right to review additional sources of evidence and consult with external reviewers to assist in evaluating dossier submissions for making recommendations for coverage determinations. Submission of a dossier does not guarantee service coverage.

To submit an evidence dossier, please download and complete the Dossier Submission Form. If Dossier submissions are incomplete, they will not be reviewed and the submitter will be notified. All dossier submissions should include the PICO framework (Population, Intervention, Comparator, Outcome) and make specific references to all potential patient harms.

Please send six hard copies and four electronic copies (on USB devices) to:

  • Department of Health
    Office of Health Insurance Programs
    Empire State Plaza
    Corning Tower (OCP-720)
    Albany, NY 12237
    ATTN: Dossier Review Unit

If you have questions concerning the Dossier process, please contact the Department of Health at dossier@health.state.ny.us or (518) 473-2160.

Coverage Determinations

Services that have been reviewed through the Dossier Process and resulting coverage determinations will be listed below.