MRT 1115 Waiver Amendment Updates Submitted to the Centers for Medicare and Medicaid Services (CMS)

  • 1115 Waiver Demonstration Proposal and Concept Paper - (Web) - (PDF) - August 25, 2021

On November 27, 2019, NYSDOH submitted an 1115 Medicaid Waiver amendment request to the Centers for Medicaid and Medicare Services (CMS) seeking both a one-year extension of the current waiver program and a subsequent three-year renewal to allow the State to build upon the transformation started in the current waiver and continue on the road to Value-Based care. This formal waiver extension proposal, which requests both unused funding from the original waiver to continue supporting the current program and additional federal funding to support a new health care transformation framework, totaling $8 billion over a four-year period, is being submitted following a public comment period and has been finalized to reflect two public forums and hundreds of written comments.

  • Formal 1115 Waiver Amendment Request - (Web) - (PDF) - November 27, 2019
  • Exhibits 18 and 19 Budget Neutrality and Historical Expenditure - (Web) - (PDF) - November 27, 2019
  • Executive Summary NYS Department of Health Submits Formal Request to Continue Groundbreaking Medicaid Waiver - (Web) - (PDF) - November 27, 2019
  • CMS Letter of Completeness - (Web) - (PDF) - December 10, 2019
  • Moving to Value-Based Care, New York´s Medicaid Section 1115 Waiver Webinar - December 11, 2019
  • CMS Amendment Request Response (Web) - (PDF) - February 21, 2020

On September 17, 2019, NYSDOH provided notice of the State´s intent to request approval from the Centers for Medicare and Medicaid Services (CMS) for a four-year waiver amendment to further support quality improvements and cost savings through the DSRIP program. As with the original MRT waiver, New York State seeks a continuation of DSRIP for the one-year balance of the 1115 waiver ending on March 31, 2021 and conceptual agreement to an additional three years from April 2021 to March 31, 2024. Thus, the full four-year extension/renewal period (one-year extension and three years of renewal) would span from April 1, 2020 through March 31, 2024.

Governor Andrew M. Cuomo announced on April 14, 2014 that New York has finalized terms and conditions with the federal government for a groundbreaking waiver that will allow the state to reinvest $8 billion in federal savings generated by Medicaid Redesign Team (MRT) reforms. The MRT waiver amendment will transform the state´s health care system, bend the Medicaid cost curve, and ensure access to quality care for all Medicaid members.

The Medicaid 1115 waiver amendment will enable New York to fully implement the MRT action plan, facilitate innovation, lower health care costs over the long term, and save scores of essential safety net providers from financial ruin. The waiver allows the state to reinvest over a five-year period $8 billion of the $17.1 billion in federal savings generated by MRT reforms.

The waiver amendment dollars will address critical issues throughout the state and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. Safety net providers will be required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement. Single providers will be ineligible to apply. All DSRIP funds will be based on performance linked to achievement of project milestones.

In addition, the special terms and conditions also commit the state to comprehensive payment reform and continuing New York´s effort to effectively manage its Medicaid program within the confines of the Medicaid Global Spending Cap.

Governor Cuomo has aggressively advocated for waiver amendment approval over the past 18 months and repeatedly made the case to HHS Secretary Kathleen Sebelius on the state´s need for MRT savings reinvestment to transform the health care delivery system. The MRT Waiver Amendment will pave the way to continue the efforts of the MRT in advancing reform and transformation in New York´s health care delivery system.

More information on the MRT Waiver Amendment documents and DSRIP program, opportunities to provide public comment, and supplemental materials providing additional information is available here.