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HEAL NY Phase 21 - Restructuring Initiatives in Medicaid Redesign RFA

The 2011-12 Final Budget secured $86.4 million to provide resources to uniquely situated hospitals, nursing homes, clinics and home care providers to reconfigure business strategies and clinical services to better meet community health care needs. The Department has recently released a portion of these funds as part of the HEAL 21 allocation leaving a balance of $61.6 million to be allocated this state fiscal year.

Awardees have been notified and include:

Hospitals

  • River Hospital, Inc
  • Niagara Falls Memorial Center
  • NuHealth/North Shore - LIJ
  • Lincoln Medical & Mental Health Center
  • Richmond University Medical Center
  • St. Barnabas Hospital
  • HHC/Woodhull Medical & Mental Health Center
  • Carthage Area Hospital, Inc.
  • Oswego Hospital

Nursing Homes

  • M. M. Ewing Continuing Care
  • Field Home - Holy Comforter

DTCs

  • Hudson River HealthCare, Inc.
  • Medalliance Medical Hlth Srvs, Inc.

The Department has and will continue to work with stakeholders and trade groups to define qualifying facilities in order to ensure that these limited resources are most effectively allocated. Generally, a qualifying facility will be evaluated based on the following four criteria:

Facility Financial Viability – The VAP/Safety Net plans must include specific actions for achieving long term financial stability, including benchmarks to measure performance in achieving the goals outlined in these plans.

Community Service Needs – All proposals will be evaluated in context of ensuring the facility is meeting community health needs. It is anticipated that many VAP/Safety Net plans will include a reconfiguration of services from intensive inpatient acute care to providing greater access to, and higher quality primary care services. Moreover, favorable consideration will be provided to hospitals and health systems in both rural and urban communities that have actively collaborated with regional stakeholders in conducting their community health needs assessments and in developing an actionable plan to meet those needs, or are pursuing integration with other providers. Active engagement in regional planning and the support of the regional planning organization (in regions where such organizations are operating) will be an important factor in evaluating applications. In addition, favorable consideration will also be extended to providers that need immediate or shorter term funding to achieve defined operational goals such as a merger, integration, closure, or service reconfiguration. It should be noted that New York State is currently working with stakeholders to align the state's community service plan requirements with the ACA's community health needs assessment requirements.

Quality Care Improvements – The initial analysis of Safety Net facilities indicates that some providers perform in the lower quartile on certain quality performance measures. VAP/Safety Net plans will target improvements in these areas.

Health Equity – A greater weight will be given to those VAP/Safety Net plans that address disparities in health services, or providing care to vulnerable populations who are at greater risk for experiencing poorer health outcomes than the general population.

In order to expedite processing of potential VAP/Safety Net funds the Department is requesting that interested providers complete the attached mini-application by October 17, 2012. You will see that this form is intended to be brief and asks for 1) a general description of the project and how it will better meet the needs of the community (i.e., patient centered and community health delivery system related); 2) data on the population served including payor-mix; 3) program objectives including improved patient outcomes, reduced inpatient stays, and increased access to ambulatory care services; and 4) immediate and longer term financial condition of the facility including improved operating margins, debt to capital coverage, and fund balances.

Once the Department has received the mini-applications, those selected will be expected to development a full proposal. A copy of a Temporary Medicaid Rate Adjustment Agreement (TMRAA) package (including a workplan, budget, and timeline) will be posted on the web and facilities will have 30 days to return the completed and signed TMRAA to the Department. The Department and the various trade groups are committed to providing direction and assistance to ensure these applications are complete and meet the program objectives. The Department also has selected potential Strategic Planners to provide additional assistance.

We understand there will be a high demand on these funds. However, we are engaged in MRT Waiver discussions with the Federal government for $1 billion of additional funding over five years. These discussions are ongoing and we are hoping to get CMS approval for additional funding by the end of this year.

If you have questions please contact BPACR@health.state.ny.us.