BILL NUMBER: S2126

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to requirements for
certain state programs to obtain federal financial supports for the
implementation of a delivery system reform incentive payment program

 
PURPOSE OR GENERAL IDEA OF BILL:

To designate at least 40% of the federal funds awarded to the State as
part of the second phase of DSRIP for community-based health care
providers.

 
SUMMARY OF PROVISIONS:

Section 1 amends social services law § 363-a to specify that at least
40% of the funds the State receives for DSRIP 2.0 shall be designated
for community-based health care providers, defined as:

              

- a diagnostic and treatment center, other than those owned, operated,
or controlled by a general hospital

- a mental health outpatient provider

- a substance use disorder treatment provider

- a clinic licensed or granted an operating certificate by OPWDD

- a patient-centered medical home other than those owned, operated, or
controlled by a general hospital

- a community-based program funded under the office of mental health,
the office for people with developmental disabilities, the office of
addiction services and supports or through a local government unit
(except programs eligible for funding as part of a DSRIP social determi-
nant of health network)

- a home care provider

- a hospice provider

- a family and child service provider licensed under article
twenty-nine-1 of the public health law.

Section 2 is the effective date.

 
JUSTIFICATION:

In November 2019, the State submitted a proposal to CMS requesting $8
billion to implement a new DSRIP program, which would run from April
2021 to March 2025. Although the first phase of DSRIP brought about
significant improvements in patient outcomes, decreases in unnecessary
inpatient and emergency room use, and reduced costs, the community-based
providers that made many of these improvements possible were largely
excluded from the value-based arrangements led by hospitals. The DSRIP
2.0 waiver application takes some small steps away from the hospital-
centric performing provider system (PPS) model, but it still relies
excessively on hospitals as the organizing entities for the delivery of
waiver funds and the responsibility for population health improvements.

During the initial phase of DSRIP it became clear that too often, hospi-
tal systems did not move quickly enough to adopt value-based arrange-
ments, and certainly did not distribute funds to other PPS participants
in a timely or responsive manner. One way to improve this system is to
invest more directly in community-based care. Only through this direct
investment can the State achieve a truly sustainable and value-based
system.

The DSRIP 2.0 approach includes a $1.5 billion set aside for "social
determinant of health networks" (SDHN), which the Department of Health
has explained will consist of organizations that provide evidence-based
interventions addressing housing instability, transportation, food inse-
curity, interpersonal safety, and toxic stress. Given that the SDHN
organizations have their own set aside, it is imperative that the commu-
nity-based organizations providing front-line, comprehensive, primary
health care services to the majority of patients also have direct access
to DSRIP 2.0 funds.

Community-based health care services improve population health and
outcomes, and they save lives and money. Community-based care is often a
lower-cost alternative to institutional care, and is a vital support to
the acute care system. This legislation would ensure that future DSRIP
funds are dedicated to support community-based providers, including
community health centers, behavioral health providers, home care and
hospice providers -- the trusted health care providers on whom so many
vulnerable New Yorkers rely.

 
PRIOR LEGISLATIVE HISTORY:

2019-2020: S7776A/A10010A Gottfried

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.