On April 14, 2014 Governor Andrew M. Cuomo announced that New York has finalized terms and conditions with the federal government for a groundbreaking waiver that will allow the state to reinvest $8 billion in federal savings generated by Medicaid Redesign Team (MRT) reforms. The waiver amendment dollars will address critical issues throughout the state and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. DSRIP partners will be required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement.
Samaritan and North Country Initiative have taken the lead on this reform for our area and with this; a new compliance program has been initiated.
DSRIP is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.
All DSRIP funds will be based on performance linked to achievement of project milestones.
In order for your practice/agency to receive these special funds, they are required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement.
It is important that we track the DSRIP dollars to ensure that the money is not connected with fraudulent behavior/practices.
The focus of our program is on ethics and integrity in the workplace, and compliance with federal and state laws related to fraud, false claims, theft or embezzlement, kickbacks or other violations.
8 Elements to an Effective Compliance Program:
- Designation of a Compliance Officer and Compliance Committee
- Written policies and procedures
- Effective communication
- Conduct effective training
- Internal monitoring, conducting audits
- Risk assessments
- Corrective actions
What is your role? Your involvement can help maintain our culture of compliance. Here’s how:
- Be willing to take those extra steps concerning your compliance duties
- When in doubt, check policies or ask your Supervisor or other resources if there are uncertainties
- The best way to prevent compliance issues is to identify problems early
- Know what is in the Code of Conduct and strive to achieve and sustain those standards
- Feel free to contact the Compliance Officer and ask questions
- It is better to ask questions and raise issues than to leave matters unresolved
- If it feels wrong, it may very well be wrong –so check it out
- Know, in general, about laws and regulations that are relevant to your duties
- Regard auditing and monitoring findings as opportunities for improvement
- When new policies/procedures are implemented, take time to study them and incorporate them into your job
- Ask questions and be flexible
- If you suspect that quality indicators are being falsely reported to satisfy DSRIP requirements, report it
- If you suspect that a provider is falsifying documentation on their Medicaid patient, report it
Ways to make a report:
- Submit a DSRIP compliance concern online (click here)
- Your Supervisor
- Corporate Compliance Officer 315-779-5228
- Hotline 1-800-253-2856
Reporting incidents using the hotline allows:
- You to remain anonymous if you don’t leave your name
Things to remember:
- Do not ignore suspected non-compliance - CALL
- It is your ethical obligation as an employee or agent of DSRIP
- All allegations will be investigated thoroughly and in a timely manner
- Under no circumstances shall the good faith reporting of any information serve as the basis for any retaliation of reprisal in any form against any employee as a result of that person participating in the compliance efforts
Visit the NYS Department of Health DSRIP information page at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/
Answers to frequently asked questions can be found by visiting https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_faq.pdf