New York State 1115 Medicaid Waiver Amendment
Earlier this year, CMS approved a just under $7.5 billion amendment to New York’s Medicaid 1115 Waiver, allowing the state to make investments in Medicaid initiatives that expand access to primary and behavioral health, address health-related social needs (HRSN) to reduce disparities and promote health equity, transform care delivery, and strengthen the healthcare workforce.
Major components include the development of Social Care Networks of contracted CBOs to provide health related social needs (HRSN) services, Hospital global budgets for Medicaid coordinated with the CMS AHEAD initiative, workforce funding, a Medicaid rate increase and enhanced monthly payments through a Primary Care Delivery System Model.
How COPE Health Solutions can enable your success under the NY Medicaid Waiver Amendment:
- Global Budget Hospitals
- Strategic alignment – NY Waiver, AHEAD and other CMS program requirements review, strategic vision-setting and overview of key success factors for global budgets and risk
- ARC comprehensive population health management platform to enable parallel success with Global Budget and remaining VBP agreements, including MSSP ACOs, including integration with EMR, local HIE/QE and closed loop referral platform used by local SCN
- Optimized data driven care model (complex CM, disease management, care coordination, care transitions) that aligns with NY Waiver/AHEAD requirements for success
- Financial modeling for global budget and pro forma for global budget and VBP agreements to optimize revenue and understand scenario impacts
- Current payer contract analysis and proposed term sheets related to revenue enhancement and delegation during the 2-3 years prior to global budget and for non global budget impacted lines of business
- Expert team, templates and tools to develop the required “custom roadmap” in such a way as to enable success in both Global Budget and remaining VBP agreements, including MSSP ACO
- Enable alignment of VBP models across professional and institutional risk pools to create win-win financial and operational relationships with local risk-bearing IPAs and ACOs
o Targeted primary care and overall network development, including recruitment, ambulatory footprint growth plan, and physician value proposition - “Co-management” opportunity to develop and operate collaboratively the management services organization (MSO) functions required to enable success in both Global Budget and remaining VBP agreements, including MSSP ACO
- IPAs and ACOs
- Expertise in value based contracting and operations enabling alignment of VBP models across professional and institutional risk pools to create win-win financial and operational relationships with Global Budget hospitals
- ARC comprehensive population health management platform to enable success with VBP agreements, including MSSP ACOs, and aligned risk agreements with Global Budget hospitals, including integration with EMR, local HIE/QE and closed loop referral platform used by local SCN
- Social Care Networks
- ARC integration with either FindHelp or UniteUs closed loop referral platform, as well as HIE/QE, to meet overall IT infrastructure and HRSN performance reporting and ROI requirements
- CBO readiness financial and operational assessment tool
- Community Based Organizations
- CBO readiness financial and operational assessment tool
- Advisory and implementation consulting support
Thought Leadership
New York State 1115 Medicaid Waiver Amendment: Understanding Opportunities and Impacts
New York State 1115 Medicaid Waiver Amendment and Aligned Programs “Cheat Sheet”
New York State 1115 Medicaid Waiver Amendment: Social Care Networks
Medicaid Global Budgets for Downstate New York Safety Net Hospitals
