Bureau of Social Determinants of Health

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December 2019

Bureau of Social Determinants of Health

History

The Bureau of Social Determinants of Health (BSDH) was established in December 2017 (formerly Bureau of Supportive Housing) to implement the Value Based Payment (VBP) Roadmap requirements regarding Social Determinants of Health (SDH) and Community Based Organizations (CBOs).

Purpose

Transform the New York State Healthcare delivery system by integrating health and human services. Addressing the Social Determinants of Health to improve the quality of care and health outcomes for NYS most vulnerable populations.

circle showing cbos to health systems to data to medicaid reform to helaht outcomes back to cbo's

Review of SDH and CBO Requirements

To ensure the long-term sustainability of the improvements made possible by the DSRIP investments in the waiver, the Terms and Conditions (T&Cs) (§ 39) require the State to submit a multiyear Roadmap for comprehensive Medicaid payment reform, which was first approved by Centers for Medicare and Medicaid Services (CMS) in July 2015. Page 50 of the VBP Roadmap outlines the standards and requirements for Public Health and Social Determinants of Health.

  1. All new and existing VBP Level 2 & 3 arrangements MUST include:
    1. At least one Social Determinant of Health Intervention
    2. At least one Tier 1 Community Based Organization (this does not exclude Tier 2 and 3 CBOs)
  2. MCOs must provide upfront funds or startup funding to the provider/CBO for the social determinants of health intervention.
  3. The MCO/MLTC/VBP Contractor may decide on their own SDH intervention. Interventions should be measurable and able to be tracked and reported to the State. SDH Interventions must align with the five key areas of SDH, which include:
    • 1) Education, 2) Social, Family and Community Context, 3) Health and Healthcare, 4) Neighborhood & Environment and, 5) Economic Stability
  4. VBP Level 2 & 3 contracts without SDH and CBO requirements will not meet the definition of VBP.

Tier 1, Tier 2, and Tier 3 CBO Definitions

  1. Tier 1 CBO
    • Non–profit, non–Medicaid billing, community based social and human service organizations
      • e.g. housing, social services, religious organizations, food banks
      • All or nothing: All business units of a CBO must be non–Medicaid billing; an organization cannot have one component that bills Medicaid and one component that does not and still meet the Tier 1 definition
  2. Tier 2 CBO
    • Non–profit, Medicaid billing, non-clinical service providers
      • e.g. transportation provider, care coordination provider
  3. Tier 3 CBO
    • Non–profit, Medicaid billing, clinical and clinical support service providers
    • Licensed by the NYS Department of Health, NYS Office of Mental Health, NYS Office for Persons with Developmental Disabilities, or NYS Office of Alcoholism and Substance Abuse Services.

Bureau of SDH Activities

Implement the VBP Roadmap Requirements Related to SDH and CBOs Stakeholder Engagement Develop SDH Measures in Population Health and Payment Reform DSRIP 2.0 SDHN Housing is Healthcare
Review VBP Level 2 and 3 contracts and amendments Webinar series for, MCOs, VBP Increase data collection on SDHs (i.e. electronic health records) NYS has formally submitted a 1115 Medicaid waiver amendment to CMS (11/27).
A component of the waiver seeks approval to create regional Social Determinants of Health Networks (SDHN) to develop a formal network of CBOs that will deliver social determinant of health services		 Continue to partner health systems with supportive housing providers for referrals and care coordination
Track SDH interventions and CBO contracts Maximize CBO and SDH interventions in the health care system SDH Assessment Tool and Z–code alignment Research and evaluation on housing programs to demonstrate the positive health outcomes, and cost effectiveness of supportive housing as a intervention
Continue to work with State agencies to coordinate SDH activities across the State Standardize SDH Quality Measures and incorporating into QARR

For Additional Information:

Contact us:

Bureau of Social Determinants of Health SDH@health.ny.gov