Centers for Medicare and Medicaid Services (CMS) Official Documents

New York 1115 Medicaid Waiver Information

New York State–s Medicaid Section 1115 Medicaid Redesign Team (MRT) Waiver (formerly known as the Partnership Plan) has achieved significant results in meeting its major goals of improving access, quality, and cost effectiveness of health services for the poorest and most at risk residents. The waiver, which has operated since 1997, has allowed the State to implement a managed care program which provides comprehensive and coordinated health care to Medicaid recipients, thereby improving their overall health coverage. This webpage provides resources to those who are interested in the waiver and would like to contribute to the effort.

Please email questions, comments, or concerns to: 1115waivers@health.ny.gov.

New York State is well–positioned to lead the nation in Medicaid reform. Governor Cuomo´s Medicaid Redesign Team (MRT) has developed a multi–year action plan (A Plan to Transform the Empire State´s Medicaid Program) that, when fully implemented, will not only improve health outcomes for more than five million New Yorkers but also bend the state´s Medicaid cost curve. Significant federal savings have already been realized through New York´s MRT process and substantial savings will also accrue as part of this action plan.

MRT Waiver Amendment/DSRIP Special terms and Conditions (STCs)

DSRIP Project Toolkit

The DSRIP Project Toolkit was created to help Performing Provider Systems understand the core components of each DSRIP project. The Toolkit describes how DSRIP projects are distinct from each other as well as the state´s rationale for selecting each project. The projects provided in this toolkit are a compilation of strategies and recommendations submitted by the public with input from a number of state agencies/partners. The core components and other elements of the project description will be used as part of the DSRIP Project Plan checklist in the DSRIP Project Plan application review process. To assist providers in project selection, each project´s value has been included for reference. Project index scores are based upon a grading rubric that evaluated the project´s ability to transform the health care system.

The DSRIP Project Toolkit was finalized late August 2014 and now includes project 2.d.i (the 11th project). The DSRIP Project Toolkit was updated in October 2014 to align with the reporting measures outlined in Attachment J.

Quality Strategy of the New York State Medicaid Managed Care Program, 2014

As part of the Special Terms and Conditions (STCs) for the New York´s Federal–State Health Reform Partnership (FSHRP) and Partnership Plan section 1115(a) Demonstrations, the state is required to maintain a Quality Strategy for all Medicaid Managed Care Programs. Any updates, amendments, or waivers to the FSHRP or Partnership Plan require revision of the Quality Strategy to incorporate changes. The Quality Strategy is also assessed every three years using assurance reports, surveys, and findings. Changes in the Quality Strategy are made available for public and stakeholder comment. The latest version of the Quality Strategy for New York State Medicaid Manage Care Program was approved by Center for Medicare & Medicaid Services on December 24, 2014.

DSRIP Measure Specification and Reporting Manual

The DSRIP Measure Specification and Reporting Manual contains information about the reporting requirements for performance measures associated with projects. The manual describes the data sources, measure steward, resources, reporting timeframes, required information to be provided by the Performing Provider Systems, and file layouts. The manual also contains the performance goals for the measures in Domain 3, the methodology for establishing the annual improvement target, and the mechanism for achieving high performance funds for the ten measures identified for the extra payment. A draft version of the manual was originally posted in October 2014 for public comment. A revised version was posted in April 2015 to incorporate many of the suggestions received. The manual was further revised as measure production began and these revisions were incorporated in October 2015, including methods for addressing retired measures and changes to measures which was approved by CMS. Below are the final Measurement Year 1 (MY1) and Measurement Year 2 (MY2) DSRIP Measure Specification and Reporting Manuals as well as the redline versions of each document.

Attachment K: DSRIP Operational Protocol

Describes requirements for DSRIP Operational Protocols.

Attachment L: DSRIP Quarterly Report Guidelines

Describes requirements for New York´s reporting to CMS.

For more information on the New York 1115 Medicaid Waiver, please click here.