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Brooklyn hospitals hear from state about applying for Medicaid Waiver funds

Troubled hospitals could apply for interim funding

April 17, 2014 By Mary Frost Brooklyn Daily Eagle
Mayor Bill de Blasio with Gov. Andrew Cuomo in Albany in January.
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Just four days after Governor Andrew M. Cuomo announced that New York had finalized a deal with the federal government for $8 billion in Medicaid waiver funds, the state Department of Health (DOH) hosted a “MRT Waiver Extension” public hearing in Downtown Brooklyn on Thursday to answer questions from struggling Brooklyn hospitals and other healthcare providers about how to apply for the funds.

Governor Cuomo said earlier this years that a large chunk of that money could be headed to Brooklyn for institutions like Interfaith Medical Center and Brookdale.

The auditorium at New York City College of Technology (City Tech) was near-capacity as health executives and grant writers soaked up the 100-plus-slide presentation given by Jason A. Helgerson, New York State Medicaid Director and Executive Director for New York’s Medicaid Redesign Team.

The goal of the funding program is to transform the health care safety net across New York State over the five-year program period, Helgerson explained. The state has built in incentives to reduce “avoidable” hospital use by 25 percent, increase the use of managed care, and provide better care at less cost through the Delivery System Reform Incentive Program (DSRIP).

DSRIP accounts for most – $6.42 billion – of the waiver. These payments are provided to hospitals that have developed methods of cost-effectively improving results for their patients by hitting certain benchmarks, such as reducing visits to the ER. An additional $1 billion would support home health care, investment in training, and improved services for behavioral health.

Participating providers would have to conduct a study of their community’s healthcare needs and select strategies tailored to meet those needs, and payment of funds would be performance-based. The amount of funding a health care organization receives will be based on the number of projects selected, the number of Medicaid patients served, and the quality of the projects.

An independent contractor, not DOH, will judge the applications, Helgerson said. DOH will be providing advice to those applying, and will help institutions tweak their applications before the final deadline.

Brooklyn is the “epicenter” of financially-challenged hospitals on the verge of closure, Helgerson said. As a short-term measure, these hospitals “need to get immediate cash assistance to avoid catastrophe.”

While the state is playing the long game with health delivery reform, “Transformation can’t be done in a matter of weeks. If forced to move too quickly, we’ll get poor proposals,” he said.

To that end, the state has created an Interim Access Assurance Fund, “a one-year, one-time-only program to serve as a bridge to the full-fledged DSRIP program.” He added that participants would be required to participate in the full DSRIP program to get the interim funds.

A total of $500 million dollars has been set aside for the interim program, with $250 million to be directed to public hospitals and $250 million to non-public hospitals.

Helgerson dove deeply into the application process but left the audience with five key themes: collaboration, project value, payment for performance, knowledge sharing, and permanent transformation after the five-year period.

Of these, the most important is collaboration, he said. “We will not accept applications from a single provider,” but rather a community of providers. “We encourage providers to start talking and working with other providers,” he said.

The waiver allows the state to reinvest the billions in federal savings generated by Medicaid Redesign Team (MRT) reforms. “We will finally be able use the billions in savings we generated by reforming the state’s Medicaid system to protect and improve health care services for millions of New Yorkers,” Gov. Cuomo said in a statement on Monday.

Mayor Bill de Blasio, who as Public Advocate played an active role in working to solve Brooklyn’s hospital crisis, said the announcement was “a major milestone that will help break the vicious cycle of heedless hospital closures across our city.”


Q and A

Helgerson answered a number of questions from attendees, and also recommended that people send in comments to DOH.

Wendy Stark, Senior VP, Lutheran Family Health Centers, asked detailed questions about the methodology used in patient “attribution” to providers, and how to attribute homeless populations. While Helgerson supplied some answers, he allowed the issue was complex and “We still have to think about” some issues.

A representative from CUNY’s Central Office asked if funds would be available to the system for retraining healthcare workers. “Workforce strategy assessment is part of the application,” Helgerson said. “CUNY sounds like a logical partner” for providers in the city.

A representative of the Performance Logic healthcare management company questioned the ability of smaller institutions to handle the project management necessary for a successful application.

“Project management is going to be key,” Helgerson said. But he added that the state hoped to simplify thing by creating systems. “We require projects to use our methodology. We’ll be working with them, and require they report every two weeks or monthly.” Still, he said, providers should “hire experienced project managers to help them stay on top, and have a system in place.” The state is developing a two-way portal to help providers access Medicaid data, information about members, and report back to the state, he said.

A representative from SUNY Downstate asked about inequities in attribution. “The west side of Flatbush has healthy babies; the east side has chronic diseases. But we all get $8 a month per patient,” she said. “Is there any risk adjustment?”

“We did ask CMS about graduated fees, but they were loath to do that,” Helgerson said. “They wanted a single measure. There was criticism that there would be a focus on higher needs adults, and kids would be left behind.”

Lowell Feldman, president at Terrace Healthcare Center in the Bronx, commented, “It’s nice to see the New York State Department of Health offering consultative services again. It’s been a long, long time.”

Shena Elrington, Director, Health Justice Program for the New York Lawyers for the Public Interest submitted written testimony expressing support and excitement about the promise of the waiver funding to drive system reform. However, “The devil is in the details,” she said.

“This process will only be successful if those details encourage transparency, accountability, and meaningful community and stakeholder input.” She asked if there would be community representatives or advocates for low-income communities and communities of color, the disabled and underserved neighborhoods at the table helping the state make these key decisions. “Will there truly be any meaningful way for advocates and community members to participate in the application and decision making process?”

In terms of public input, Elrington said, “We have gotten off to a rough start. We had little notice of these hearings, only receiving information recently, and the hearings are taking place during a time of many religious holidays. If the state is serious about having a meaningful stateholder engagement process, then it must provide us with real opportunities to be heard.”

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