New York’s 1115 Renewal Update: It’s All About the Technical Details

Written by Kalin Scott

State is Saving Big-Ticket Policy Discussions for a New Administration

Earlier today, New York Medicaid officials provided more detail on their current approach to renewing the state’s 1115 Medicaid Redesign Team (MRT) Waiver. The waiver will expire on March 31, 2021, and is subject to approval by the Centers for Medicare and Medicaid Services (CMS.)

The major takeaway from today’s presentation — New York is not including any big policy objectives or initiatives in this renewal. The state is seeking a three-year renewal strictly focused on preserving existing waiver programs and enabling the 1115 waiver — first approved in 1997 — to continue. The goal of the extension is to preserve current waiver-authorized programs and funding authorities and includes no new policy initiatives for review. New York will also be one of the first states to incorporate updated budget neutrality rebasing in its waiver renewal, which may ultimately limit the state’s flexibility in implementing new programs down the line.

What’s the Background on the State’s MRT Waiver?

New York has had an approved 1115 Waiver for more than 20 years, and it has served as a platform on which the state has built innovative policy and programmatic initiatives through periodic amendments. One notable example is the state’s Delivery System Reform Incentive Payment (DSRIP) program, which was approved in 2014, and expired earlier this year.

In recent years, the current administration at CMS has turned down and/or declined to consider several recent New York amendment requests focused on policy priorities including an initiative focused on criminal justice reform, extension of the state’s DSRIP program, and initiatives to respond to the COVID-19 pandemic.

What Does this Mean for DSRIP, VBP and Other State Priorities?

While this strategy means the waiver renewal will not include any new investments in key policy areas, the state team was clear: New York Medicaid’s priorities have not shifted. Recently submitted amendments that were not approved and/or not considered remain the priorities of the state’s Medicaid program, and will be advanced in one form or another under a new administration. This means what was outlined in last year’s criminal justice reform amendment, last fall’s DSRIP waiver amendment, this year’s Public Health Emergency application, and other recent submissions still strongly signal the state’s desired path forward. (Read my previous posts highlighting the state’s priorities in these applications.) These priorities include DSRIP continuation, expansion of value-based payment arrangements, workforce investment, expanded telehealth, and criminal justice reform.

So, What is in the Waiver Renewal?

The major components of the three-year extension:

· Preserve Current Programming: The current 1115 MRT Waiver authorizes key long-standing managed care programs such as mainstream managed care, managed long term care, health and recovery plans (HARP), HIV/SNP plans, some children’s home and community based services, and the state’s self-direction pilot. Renewal would continue the STCs and funding authorities that govern these programs.

· Align with MRT II Initiatives: New York will include two components related to MRT II initiatives — the transition of pharmacy from managed care to fee-for-service in alignment with the proposed Pharmacy Carveout, and the transition of MLTC non-emergency transportation to fee-for-service to implement the transportation broker initiative.

What is New York’s Timeline?

Waiver documents are still under development, will be released to the public in mid-December, and the state expects to formally submit its renewal application in early March.

· 12/16/20–1/15/21: Public Comment period. Announcement and link to waiver document will be posted in NYS Register.

· 1/21/21 & 1/27/21: Public hearings will be conducted virtually.

· Early March: State’s submission of final waiver extension request to CMS.

· Proposed Extension Period: 4/1/21–3/31/24

Ok, So What Exactly is an 1115 Waiver?

1115 waivers are a vehicle for state Medicaid programs to pilot and evaluate innovative care delivery and coverage models across their Medicaid population. Section 1115 of the Social Security Act gives the Secretary of Health and Human Services the ability to sign agreements with states waiving certain provisions of Medicaid to be able to test these programs. Waivers are typically approved for an initial 5-year period, and then renewed for periods of 3 to 5 years. Recently, CMS has approved some 1115 waiver renewals for a period of 10 years.

1115 Waivers include funding authorities, detailed and technical terms and conditions outlining program requirements, and comprehensive reporting and evaluation requirements. More than 40 states have an 1115 waiver.

If you want to learn more about 1115 waivers, this is a great resource.

How Can I Learn More?

The state committed to putting information from today’s announcement on its MRT II web page — if it’s not there yet, it should be soon. Additional information will be distributed through its MRT listserv — signup instructions here.

What do you think about the announcement? Have any questions or opinions about what all of this means? You can find me on Twitter @kalinscot or by email — I’d love to hear what you think.