SAE’s DSRIP Services:

SAE has experts in health and behavioral health integration able to leverage health information technology (HIT), integrate collaborative care, and promote Evidence Based Practices (EBPs) to promote wellness for those with behavioral health conditions.

SAE’s reform experts can facilitate strategic linkages for targeted communities and special needs populations across the state, and conduct customized community needs analyses utilizing available state health data.

SAE’s health information technology expert, Amy Machtay specializes in HIT for behavioral health providers and can provide HIT gap analysis and workflow planning.

We have experts in Continuous Quality Improvement and rapid cycle change, including Mat Roosa, ACSW, LCSW-R, as well as several consultants who are Six Sigma certified.  

For more information about our related services, see SAE's Managed Care for CBOs page.

For more information about opportunities for Behavioral Health in the DSRIP:

DSRIP and Behavioral Health

The DSRIP includes project options organized by the following four domains. PPS’s will choose projects that correspond with documented needs identified by a thorough assessment of community needs documented for the area’s Medicaid population.

Domain 1 includes the Overall Project Process Elements for all Projects within the PPS. This domain includes the work plan with specific process measures and milestones for each of the projects as well as the technology, tools, and human resources needed for DSRIP activities.

Domain 2 includes the Projects and Metrics related to System Transformation.  Each Provider System must select at least 2 projects in this domain, which is focused on creating an integrated delivery system, designing more robust transitional care, and creating a seamless experience for patients moving through the PPS.

Projects in this domain that most closely relate to behavioral health include:

  • Health Home Creation for higher risk patients not currently health home eligible, via primary care access combined with support services
  • Medical Village/Alternate Housing Design for those using present nursing homes
  • Transitional supportive housing services
  • Development of community-based health navigation services
  • Expanded use of telemedicine

Domain 3 includes Projects Related to Clinical Improvements. Each Provider System must include at least 2 projects within this Domain (but no more than 4). These projects focus on specific improvement for disease categories related to populations with the greatest needs.

Projects in this domain that most closely relate to behavioral health include:

Strategy Area: Behavioral Health (required for all Projects as a core strategy)

  • Evidence-based disease management in high risk/affected populations (adult only)
  • Implementation of evidence-based strategies in the community to address chronic disease –primary and secondary prevention projects (adults only)
  • Implementation of evidence-based medication adherence program (MAP) in community based sites for behavioral health medication compliance
  • Development of withdrawal management (ambulatory detox) capabilities within communities
  • Behavioral Interventions Paradigm in Nursing Homes (BIPNH)

        Strategy Area: HIV

  • Comprehensive Strategy to Decrease HIV/AIDS transmission to decrease avoidable hospitalizations—Development of a Center of Excellence for management of HIV/AIDS

Domain 4 includes Projects Related to Population-Focused Improvements. This category extends beyond the Medicaid Population to focus on integrated, population-wide plans that dovetail with the NYS Prevention Agenda, as follows:

·         Promote Mental Health and Prevent Substance Use Disorders

  • Promote mental, emotional, and behavioral well-being (MEB) in communities
  • Prevent substance abuse and other Mental, Emotional and Behavioral Disorders
  • Strengthen Mental Health and Substance Abuse Infrastructure Across Systems

·         Prevent Chronic Disease

  • Promote tobacco use cessation, especially among those with SES and those with poor mental health

·         Prevent HIV and STDs

  • Decrease HIV Morbidity
  • Increase early access and retention in HIV care
  • Decrease STD morbidity
  • Decrease HIV and STD disparities

Each PPS must plan at least two system transformation projects, two clinical improvement projects (one of which must be in the behavioral health strategy area), and one population-wide project. Each project has been given a valuation score that indicates the maximum points it can contribute to the projects overall score within the application. The most important projects relate to the required creation of the Integrated Delivery System, so these projects carry a higher value in project scoring. 

Several key changes are reflected in the revised Toolkit, as of September 2014, including the following:

Responding to the need to bring uninsured New Yorkers into the DSRIP project, CMS and the state agreed to create a new project, “Patient and Community Activation for Uninsured, Non-Utilizing and Low-Utilizing Populations,” which is designed to improve patient activation and engagement in their own health care, and to increase the use of primary and preventive care. This project carries a very high valuation (56 out of 60 points) and will likely be addressed by every plan. Project valuation is also weighted to add 10 points to the overall score for PPS’s choosing this project.

Attribution changes for special populations has been adjusted to support access to care coordination by using a 5 step assignment algorithm based on where the beneficiary has health home involvement, primary care, hospitalizations, ambulatory care, ER usage, and inpatient stays. This prioritize attribution formula will apply to those with behavioral health issues, those with developmental disabilities, and those in long term care.

Additional clarity was also added regarding the creation of integrated systems.

Timeframes

The new six-year timeframe begins now, with a “year zero” period designed to bring providers together to create strong DSRIP Project plan applications. This represents more time than was previously proposed. Reported performance during Year Zero may support planning efforts with partners.  This extension of funding is intended to support the development of strong and well-integrated Project Plans, which will be due in December 2014. By spring of 2015, Plans will move in full implementation mode.

Eligible Applicants: Safety Net Provider Definition:

Non-hospital based providers, not participating as part of a state-designated health home, must have at least 35 percent of all patient volume in their primary lines of business and must be associated with Medicaid, uninsured and Dual Eligible individuals. However, there is a Vital Access Provider Exception in which exceptions to the safety net definition may be considered on a case-by-case basis if it is deemed in the best interest of Medicaid members if a community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.

Non-qualifying providers can participate in Performing Providers Systems. However, non-qualifying providers are eligible to receive DSRIP payments totaling no more than 5 percent of a project’s total valuation, though CMS can approve payments above this amount if it is deemed in the best interest of Medicaid members attributed to the Performing Provider System.

DOH has posted preliminary lists of eligible Safety Net Providers, such as Diagnostic and Treatment providers. OMH, OASAS and OPWDD providers will be added shortly. You can access the most up to date lists on DOH’s website, here.