[NYAPRS Enews] Waiving Regulations for Integrated Care in DSRIP

[Briana Gilmore]

NYAPRS Note: The state's ability to modify regulations or state agency requirements under a new delivery system shows a promising shift toward the needs of providers to be able to integrate care successfully. The biggest impact to our community may be the ability for a primary care, mental health, or substance abuse facility with a license from DOH, OMH, or OASAS, to integrate care within their facility without additional licensure. If a new performing provider system wants to submit a waiver to ease contracting or innovative approaches to meet people's needs outside of the hospital and in the community, they are able to request that of the state. Check the website below to determine if the allowances may impact a project or service design you are currently working toward in DSRIP. Also, consider how these changes may impact service delivery in managed care or the way they could impact consumers if they were generalized in NYS and other states, which may follow in the wake of successful regional integration.

Waiving Regulations to Implement DSRIP
Crain's Health Pulse; 9/23/2014


The state Department of Health released information this month on what providers should do when DSRIP implementation collides with federal and state laws.

In a presentation to the Public Health and Health Planning Council, Daniel Sheppard, deputy commissioner of the Office of Primary Care and Health Systems Management, identified the regulatory areas for which Performing Provider Systems could request a waiver. A general guideline was posted online here<http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2014-09-17/docs/flexibility_request_upd.pdf>.

But that document is far from final, said Mr. Sheppard. "It's more a wiki that only the department will be changing," he said, as DOH speaks with providers and PPSs and engages them on what waivers they think they will need.

He cautioned that "some waivers are not possible because of federal rules or state statutes."

Waiver requests must be included in the PPS applications to DOH, due in December. None of the granted waivers will be "blanket" waivers but instead must relate to specific sections of regulations. Each waiver must be associated with a DSRIP project plan. All applications must specify the legislation for which a waiver is being requested, why the waiver is necessary, and whether the waiver could have a negative impact on patient safety.

"This isn't a 'Get out of jail free' card," said Mr. Sheppard.

He added that DOH will be available to work with PPSs and discuss waivers pre-application. The waivers will be approved at the same time applications are approved.

Antitrust issues are a major concern for the emerging PPSs. Mr. Sheppard said the DOH has no authority to waive federal antitrust law; instead, Certificates of Public Advantage can be requested to address antitrust concerns.

Other regulatory areas that won't be waived are the corporate practice of medicine and fraud and abuse statutes.
http://www.crainsnewyork.com/article/20140923/PULSE/140929979/waiving-regulations-to-implement-dsrip
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