Supplemental DSRIP Programs

Equity Programs are comprised of two programs: 1) Equity Infrastructure Program (EIP) and 2) Equity Performance Program (EPP). These programs were created to enhance a PPS´ implementation of DSRIP by having the PPS undertake activities that are vital for DSRIP´s success. In addition, the Equity Programs align PPS´ efforts towards key DSRIP metrics that are linked to the State´s vision of healthcare transformation. It should be noted that both of these programs are administered through Managed Care Organizations (MCOs), unlike DSRIP, which is administered by DOH.

EIP is paid out to PPS for participating in select DSRIP activities, which support overall DSRIP project efforts, but may not be explicitly covered by performance payments. PPS must provide evidence of participation in four (4) of the nine following activities in order to be eligible for EIP payments:

  • Participation in IT TOM initiatives
  • Participation in one of the MAX Series projects
  • Participation in expanded HH enrollment
  • EHR implementation investment
  • Capital spending on primary/behavioral health integration
  • Participation in a state recognized tobacco cessation program
  • Participation in state efforts to end HIV/AIDS
  • Participation in fraud deterrence and surveillance activities
  • Infrastructure spending related to SHIN-NY/RHIO

Note: If they so choose, PPS have the opportunity to select a new set of activities for EIP at the beginning of each new DSRIP performance year.

EPP is based on a subset of DSRIP performance metrics, which were chosen based on the following criteria:

  • Metrics are directly aimed at meeting DSRIP goals
  • Metrics that are applicable to a significant portion of the PPS population
  • Metrics that are related to important subpopulations (e.g., children ´s access to primary care)
  • Metrics critical to achieving DSRIP goals that carry lower values than other DSRIP measures
  • Metrics that are in some way connected to Value Based Payment (VBP) activities.

Please find the following list of 25 EPP measures below. DOH expects PPS to select six (6) measures that reflect the needs of their respective communities and help to support the PPS´ move to VBP with input from their assigned MCO.

EPP Measures**
Children´s Access to Primary Care – 12 to 24 months Children´s Access to Primary Care – 25 months to 6 years
Children´s Access to Primary Care – 7 to 11 years Children´s Access to Primary Care – 12 to 19 years
Prenatal and Postpartum Care – Postpartum Visits Prenatal and Postpartum Care – Timeliness of Prenatal Care
Well Care Visits in the first 15 months (5 or more Visits) Childhood Immunization Status (Combination 3 – 4313314)
Follow–up care for Children Prescribed ADHD Medications – Initiation Phase Follow–up care for Children Prescribed ADHD Medications – Continuation Phase
Lead Screening in Children Chlamydia Screening (16 – 24 Years)
Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Strategies Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Medication
Controlling high blood pressure Comprehensive Diabetes Care
Comprehensive Diabetes screening – All Three Tests Diabetes screening for persons with schizophrenia or Bipolar Disease who are using Antipsychotic Medication
Diabetes monitoring for persons with schizophrenia Adherence to anti–psychotic medications for individuals with schizophrenia
Initiation and Engagement in Alcohol and Other Drug Dependence Treatment (IET) within 14 days of substance abuse episode Behavioral Health – follow up after hospitalization for mental illness (30 day)
Behavioral Health – follow up after hospitalization for mental illness (7 day) Follow–up on Alcohol and Other Drug Dependence Treatment (IET) within 44 days of initial engagement

*EPP metrics chosen must remain the same for all five years of the Program.

**At least one of the six EPP measures chosen must switch to P4P in DY2 or DY3. Metrics in bold switch to P4P in DY2 or Dy3

As indicated in the above chart, PPS must select six out of the 25 available EPP measures, and one of the six measures must be a measure that transitions from P4R to P4P in DY2 or DY3. The remaining five selected measures can switch to P4P at in any year. No EPP measures remain as P4R for the duration of the Program. For a complete listing of the DSRIP measures that switch from P4R to P4P, please refer to the DSRIP Measure Specification Guide.

It should be noted that EPP is based on performance. As such, these funds are earned only if these metrics are achieved. Achievement in EPP aligns with achievement in DSRIP. More guidance around EPP can be found in the EP FAQs and EP DY2 Guidance Document below.

As the Equity Performance Program (EPP) is based on performance measures already tracked within the DSRIP program, the DSRIP IA will perform a comparison between the PPS´ reported/achieved metrics and their baseline metrics, and will provide the percentage difference to the MCOs through DOH. MCOs should submit the following EP related information/documentation to the Independent Assessor (IA):

  1. A copy of each finalized EP MCO/PPS contract on an annual basis;
  2. The MCO´s completed EP Reporting and Payment Frequency table (or an alternative template capturing all State requested information) on an annual basis (same as the report sent to the State);
  3. The MCO´s completed EIP Activity and Payment tables (or an alternative templates capturing all State requested information) on an agreed upon frequency outlined in the EP contract (same as the report(s) sent to the State);
  4. The MCO´s completed EPP Payment table (or an alternative template capturing all State requested information) on an agreed upon frequency outlined in the EP contract (same as the report sent to the State); and
  5. All PPS submitted materials for EIP (copies of submitted evidence or attestation thereof) reviewed by the MCO, on an agreed upon frequency outlined in EP contract.

DOH does not need to approve the MCO–PPS Equity Programs contract, but a copy of the agreement should be provided to DOH in order for DOH to stay abreast on how each MCO–PPS pair plans to implement the Equity Programs. In addition, if there are any amendments to a MCO–PPS Equity Program contract (e.g., a PPS chooses to update its EIP activities), DOH should be provided with an updated contract.

The above referenced documentation should be emailed to the DSRIP IA mailbox at dsrip_ia@pcgus.com using a subject line "Equity Programs." The IA will be responsible for keeping records and documents related to the Equity Programs.

Report Completed by Submitted to Frequency Location
EP Contracts PPS & MCO IA & DOH Annually dsrip_ia@pcgus.com
dsrip_ssp@health.ny.gov
MCO EP Frequency Table MCO IA & DOH Annually dsrip_ia@pcgus.com
dsrip_ssp@health.ny.gov
MCO EIP Activity Table MCO IA & DOH Based on EP Contracts dsrip_ia@pcgus.com
dsrip_ssp@health.ny.gov
MCO EIP Payment Table MCO IA & DOH Based on EP Contracts dsrip_ia@pcgus.com
dsrip_ssp@health.ny.gov
MCO EPP Payment Table MCO IA & DOH Based on EP Contracts dsrip_ia@pcgus.com
dsrip_ssp@health.ny.gov
PPS EIP Activity Table PPS MCOs Based on EP Contracts MCO contact emails
Supporting Documentation for
EIP Activity participation		 PPS MCOs Based on EP Contracts MCO contact emails
Supporting Documentation for
EIP Activity participation		 MCO (reviewed by MCO after being sent by PPS) IA Based on EP Contracts dsrip_ia@pcgus.com

* Please note the updates to the funding and pairing table