1115 Medicaid Redesign Team Waiver: Extension Request

  • Presentation is also available in Portable Document Format (PDF)

Informational Webinar

November 18, 2020

Agenda

  • Background: Waiver Renewal Activities to Date
  • Overview: Current 1115 Extension Request and Approach
  • Potential Future Amendments
  • Next Steps
  • Questions

Background: Waiver Activities to Date

November 2019

  • New York State submits a 4-year DSRIP extension and waiver renewal request to CMS

February 2020

  • CMS declines to negotiate DSRIP extension and renewal request

May 2020

  • CMS denies the State’s administrative extension request, which was necessitated by COVID-19

June 2020 - Present

  • New York State develops 3-year extension proposal to preserve 1115 waiver authorities

Overview: Current Extension Proposal and Approach (1 of 2)

Three components:

  1. A three-year extension of the existing special terms and conditions ("STCs") and funding authorities under the current MRT Waiver;
  2. The transition of the pharmacy benefit from MMMC plans to fee-for-service (i.e., the "Pharmacy Carveout"); and
  3. The transition of the transportation benefit from MLTC plans to fee-for-service (i.e., the "Transportation Carveout").

Inclusion of the Transportation Carveout and Pharmacy Carveout aligns with Medicaid Redesign Team II (MRT II) recommendations and implementation dates.

Overview: Current Extension Proposal and Approach (2 of 2)

This approach extends current programs and waiver authorities, including Medicaid managed care, MLTC, HARP, Children’s HCBS and other programmatic features in the State’s current 1115 waiver.

Other reasons include:

  • Preserves current waiver programs during the change in presidential administration and CMS leadership;
  • Provides additional time to consider the longer-term impact of COVID-19 on New York’s health care delivery system; and
  • Allows pending and anticipated 1115 waiver amendments from the MRT II process–e.g., HCBS Behavioral Health Optimization, Duals Integration–to be reviewed and approved consistent with current implementation targets.

Potential Future Amendments

After this extension proposal is approved, New York may pursue other initiatives that require 1115 waiver authority, including:

  • Developing longer-term COVID-19 pandemic responses
  • MRT II Actions (e.g., VBP, global payment)
  • Resubmission of Criminal Justice Reform Waiver
  • Next New York State 1115 Waiver Amendments(s)

Next Steps for the 1115 Extension Proposal

Public Comment Period Begins
  • December 16, 2020
Virtual Public Hearings
  • Jan 21, 2021, 1-4pm
  • Jan 27, 2021, 1-4pm

Target Submission – Early March 2021

Current Waiver Expires
  • March 31, 2021
Waiver Extension Period
  • April 1, 2021 to March 31, 2024

Questions or Comments?

For further information, please contact us at: 1115waivers@health.ny.gov

1115 MRT Waiver Resources

1115 MRT Waiver Website

MRT II Website

Managed Care

Pharmacy Carveout

Quality Strategy