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September 23, 2022

NYS Submits 1115 Waiver Amendment (Health Equity Reform) to CMS

On September 2, 2022, New York State submitted the New York Health Equity Reform (NYHER)—an application to amend its current Medicaid 1115 Waiver1—seeking $13.52 billion over five years from the Centers for Medicare and Medicaid Services (CMS). NYHER incorporates lessons from New York State’s Delivery System Reform Incentive Payment (DSRIP) Program experience to address the “inextricably linked” health disparities and systemic health care delivery issues that have been both highlighted and intensified by the COVID-19 pandemic. 

New York State’s current 1115 Waiver demonstration was approved by CMS through March 31, 2027. This proposed amendment would overlap and extend several months beyond the existing 1115 Waiver demonstration period to December 31, 2027. NYHER has a central goal to reduce health disparities, advance health equity, and support the delivery of social care. In the amendment, New York State outlined the following specific goals, with corresponding objectives, that it hopes to achieve through the waiver:

1.    Building a more resilient, flexible, and integrated delivery system that reduces health
disparities, advances health equity, and supports the delivery of social care through: 

a)    Investments in regional planning through Health Equity Regional Organizations (HEROs)
b)    Investments in Social Determinant of Health Networks (SDHNs) 
c)    Investments in advanced value-based payment (VBP) models 
d)    Capacity building and training
e)    Ensuring access for criminal justice–involved populations

2.    Developing and strengthening transitional housing services and alternatives for people without housing, long-term institutional populations, and those at risk for institutionalization through investments in supportive housing services, with a focus on people without housing and long-term institutional populations

3.    Redesigning and strengthening system capabilities to improve quality, advance health
equity, and address workforce shortages through: 

a)    Creation of a COVID-19 Unwind Quality Restoration Pool for financially distressed hospitals and nursing homes 
b)    Investments to expand workforce capacity and develop a strong, representative, and well-trained workforce

4.    Creating statewide digital health and telehealth infrastructure by building digital and telehealth infrastructure and care models to expand access to care both in underserved areas, such as rural communities, and for underserved needs, such as behavioral health and the management of chronic diseases

All relevant NYHER documents can be found online on the NYS Department of Health’s Medicaid Waiver Information Page under “MRT 1115 Waiver Amendments.” New York State submitted its final 1115 Waiver Amendment request on September 2, 2022; CMS confirmed its completeness on September 15, 2022, and it is currently posted on Medicaid.gov for a 30-day comment period. Attorneys on Barclay Damon’s Health & Human Services Providers Team will continue to monitor developments related to NYHER.

If you have any questions about the content of this alert, please contact Herb Glose, partner, at hglose@barclaydamon.com; Bridget Steele, associate, at bsteele@barclaydamon.com; Melissa Zambri, Health & Human Services Providers Team co-leader, at mzambri@barclaydamon.com; Ron Oakes, law clerk, at roakes@barclaydamon.com; or another member of the firm’s Health & Human Services Providers Team.

                                                     

1Section 1115 of the Social Security Act allows the Department of Health & Human Services (HHS) to waive certain Medicaid program requirements and provide federal funding to states, such as New York, to pilot demonstration projects that promote the objectives of the Medicaid program.

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