MRT Waiver Amendment

Managed Long–Term Care Workforce Investment Program

May 25, 2017


  • The MRT Waiver Amendment, approved in April 2014 by the Centers for Medicare and Medicaid Services (CMS) to amend the State´s 1115 waiver, makes available up to $245 million through March 2020 for initiatives to retrain, recruit and retain healthcare workers in the long–term care sector. This initiative is being referred to as the Workforce Investment Program.
  • Workforce Investment Program will target direct care workers, with the goals of supporting the critical long term healthcare workforce infrastructure through retraining, redeployment, and enhancing skillsets.
  • Through the Workforce Investment Program, the Department of Health (DOH) will require MLTC plans, which include Fully Integrated Dual Advantage (FIDA) plans (collectively MLTC/ FIDA plans), to contract with DOH–designated workforce training centers, to:
    • Invest in initiatives to attract, recruit and retain long–term care workers in the areas they serve;
    • Develop plans to address reductions in health disparities by focusing on the placement of long–term care workers in medically underserved communities;
    • Consistently analyze the changing training and employment needs of the area that the program serves;
    • Provide for broad participation and input from stakeholders; and
    • Support the expansion of home care and respite care, enabling those in need of long–term care to remain in their homes and communities and reduce New York´s Medicaid costs associated with long–term care.

Long–Term Care Workforce Investment Organizations

  • Workforce Centers of Excellence will now be referred to as Long–Term Care Workforce Investment Organizations (LTC WIOs).
  • DOH will identify a set of minimum criteria that must be satisfied in order for an entity to be designated and operate as an LTC WIO. All LTC WIOs which meet the minimum criteria will be qualified and a comprehensive list will be made public.
  • DOH will not contract directly with the designated LTC WIOs, but will retain the ability to revoke the designation of any LTC WIO that no longer meets the qualifications set forth in their application.
  • DOH shall designate LTC WIOs through an application process. DOH will post the LTC WIO qualifications and application for public comment; a minimum of fourteen (14) calendar days is required for public input.
  • Once finalized, DOH will post the list of approved LTC WIOs.
  • Each LTC WIO will offer a menu of Workforce Development Initiatives (WDIs) which should provide training and support recruitment and retention efforts in a way that addresses the needs of plans, providers and healthcare workers in long–term care context.
  • The Department of Health (DOH) will establish a list of qualified Long–Term Care Workforce Investment Organizations throughout the state.

Workforce Development Initiatives

  • WDIs may be newly developed or based on existing programs, but must support the DOH´s ongoing efforts to transform the health care delivery system and improve population health.
  • WDIs should be consistent with and complementary to other state workforce development efforts, including those being carried out by Performing Provider Systems (PPS) under the Delivery System Reform Incentive Payment (DSRIP) Program.
  • WDIs should be focused on preparing the workforce for the changing landscape of the long–term care field.
  • DOH is aware of the Advanced Health Home Aides initiative, we are mindful of the pending regulations and will be careful not to replicate the intentions of that program.

Funding & Parameters

  • MLTC/FIDA plans will receive Workforce Investment Program funds which will be used to contract with LTC WIOs specifically for the provision of WDIs to the healthcare providers that participate with the plans.
  • MLTC/FIDA plans and LTC WIOs will also be required to collaborate on strategic planning to recruit and train new LTC workers.
  • A portion of funds will be eligible to retrain and redeploy healthcare workers in the long–term care workforce.
  • Desired outcomes are to align with the goals of Value Based Payment Reform (VBP).
  • Efforts are not meant to replicate or supplant existing initiatives.

Workforce Investment Program Regions

  • The Workforce Investment Program will be broken into six regions in alignment with the current MLTC regions:
    • Central Region
    • Hudson Valley Region
    • Long Island Region
    • North East Region
    • New York City Region
    • Western Region
  • The Workforce Investment Program is a statewide program, and DOH will seek to qualify at least two LTC WIOs in each region.
  • DOH reserves the right to revoke previously qualified LTC WIOs as well as to certify new applicants for any region in order to best serve that area´s plans, providers and workers.
  • LTC WIO applicants will be permitted to submit applications in more than one region.
  • MLTC/FIDA plans will be required to demonstrate broad accessibility of their trainings, ensuring equal access to healthcare workers employed by providers in their network as well as those who are outside their network.

Eligibility: Minimum Requirements

  • DOH will consider the following (included but not limited to) in formatting minimum criteria for eligibility:
    • Be a not–for–profit corporation established under the Not–For–Profit Corporation Law and incorporated within New York State;
    • Demonstrate experience and expertise in the development and implementation of workforce training initiatives that are cost–effective and have resulted in measurable, positive outcomes;
    • Currently offering or have the capacity to offer a training program beyond the current Department of Health minimum requirement; and
    • Incorporate adult–learner centered training techniques into training programs.

Preferred Qualifications

  • Additional preference will be given to applicants that demonstrate the following:
    • Solid training infrastructure in place, including existing procedures and staff to develop curriculum, conduct training and evaluate outcomes;
    • Proven track record of providing trainings to workers in the long–term care setting;
    • Plan to offer WDIs that are based on existing curricula where there is evidence to support achievement of positive outcomes;
      • A WDI may look to the curriculum offered in another state which has documented evidence of success
    • Provide a plan of sustainability for training solutions;
    • Demonstrate commitment to training workers in alignment with DSRIP goals to move care from inpatient to outpatient setting;
      • Retraining for new role within the workplace
      • Establishing means of identifying relevant skills and worker details
      • Demonstrating ability to establish a record of those workers trained
    • Incorporates technology to extend the reach of the training over time and geography;
    • Has strong diverse governance, including academia, employers, trainers, providers, workers and plans; and
    • Indicates a broad review of the needs of the long–term care delivery system and involves a method for prioritizing needs over time.

WDI Specifics

  • WDIs should be designed to help advance specific DSRIP objectives.
  • LTC WIOs may undertake programs to increase workforce flexibility through programs which:
    • Upgrade long–term care workers to titles with an increased scope of practice.
    • Improve a workers´ ability to communicate with patients/residents and other members of the care team.
  • In developing proposals, LTC WIO applicants will be encouraged to consult with external stakeholders to demonstrate that the needs of plans, providers and workers have been addressed.
    • MLTC/FIDA plans, long–term care providers, educational institutions and labor representatives.
  • LTC WIOs and stakeholders will also be expected to identify opportunities to recruit and train new LTC workers.

Distributions of Funds

  • Waiver funds will be allocated to MLTC/FIDA plans based on the percentage of each plan´s enrollment relative to all plan enrollment.
  • Funds will be distributed to MLTC/FIDA plans via increases to their capitated rates, and will be reconciled on a quarterly basis.
  • MLTC/FIDA plans will notify their participating providers that they can send workers to LTC WIOs to participate in WDIs without charge, subject to the plan´s approval of such participation. Plans will distribute funds to the LTC WIOs with which they contract to reimburse them for providing such WDIs.
  • DOH will take into consideration the disparity of resources available to upstate and downstate areas when reviewing applications, distributing awards and funding.

Performance Evaluation

  • MLTC/FIDA plans must report the following to DOH, on a quarterly basis (including but not limited to):
    • Information about the number of individuals trained;
    • Occupation and employer of the individuals trained;
    • WDIs in which they enrolled;
    • Results of training assessment surveys completed by enrollees;
    • Rate of completion among enrollees; and
    • Reporting to include ratio of new recruits and existing workers that successfully complete the programs.
  • DOH will require MLTC/FIDA plans to report and analyze use of funds.
  • Data to indicate what can be learned about the impact of the training offered by the LTC WIOs on patient outcomes and quality of care.
  • In the first three months of the program, MLTC/FIDA plans will convene a regional meeting with key stakeholders to develop a regional plan for workforce training priorities and menu of relevant WDIs.
    • Meetings to involve key stakeholders including but not limited to plans, providers, PPSs, workforce representatives, training entities, educational institutions, and other parties.
    • Plans will be required to report on meeting attendance and outcomes, and, together with their contracted LTC WIOs, will be expected to submit a list and training implementation plan for the regionally–selected WDIs.
  • MLTC/FIDA plans will be required to submit baseline information on compensation and benefit data, along with workforce trainings and recruitment initiatives currently offered by plans to providers and their employees.
  • The intended outcome for this project (i.e. after 2020) is to have the LTC WIOs continue operation as sustainable training centers with the ability to respond to the changing needs of the LTC workforce.

Best Practices

  • Annual meetings will be convened for panel discussions, attendees to include the following:
    • Providers
    • LTC WIOs representatives
    • Direct care workers
    • Consumers
    • Other stakeholders
    • Department of Health
  • Intent is to develop best practices and share lessons learned.
  • Plans, LTC WIOs and providers will be expected to present updates at these annual meetings.


  • In June, 2017 DOH to post application and eligibility criteria.
  • Application and eligibility criteria available for a minimum of fourteen (14) calendar days for public comment.
  • DOH to synthesize comments and finalize application and eligibility criteria.
  • DOH–approved LTC WIOs will be posted online and released directly to MLTC/FIDA plans.


  • While the Workforce Investment Program aims to support the reduction of hospital use and increase of community based care, this program is truly a testament to our belief in the LTC landscape and our commitment to enhancing the skillset of this impactful workforce. To do so effectively, we will:
    • Create sustainable LTC WIOs and training resources;
    • Offer government agencies support;
    • Create opportunity to refine program as it evolves; and
    • Continue to invest in direct care workers.


  • Please submit and comments, questions, or concerns to the BML:; DOH will be reaching out with further guidance based on the feedback received.