Delivery System Reform Incentive Program (DSRIP. The state may claim, as authorized expenditures under the demonstration, up to $1.8 billion (total computable) for five years, performance- based incentive payments to entities that support change in how care is provided to Medicaid beneficiaries through payment and delivery system reforms. DSRIP payments are an incentive for successfully meeting associated metrics and outcomes rather than payment of claims for the provision of medical care. For this reason, DSRIP payments shall not be considered patient care revenue for purposes of offsetting allowable uncompensated care costs under the Safety Net Care Pool Uncompensated Care Cost Limit Protocol under demonstration authority. DSRIP will be a time limited program, and Massachusetts’ efforts undertaken through DSRIP will be sustainable after the demonstration period concludes. Specifically, the Commonwealth may claim as allowable expenditures under the demonstration, payments to Accountable Care Organizations (ACOs), certified Community Partners (CPs), social service organizations, providers, sister agencies, full-time staff, and contracted vendors for activities that will likely increase the success of the payment and care delivery reform efforts and the overall goals as outlined above and in the 1115 demonstration. Such activities include: (1) start up and ongoing support for ACO development, infrastructure, and new care delivery models; (2) support for ACOs to pay for traditionally non-reimbursed flexible services to address health-related social needs; (3) transitional funding for certain safety net hospitals to support the transition to ACO models and to smooth the shift to a lower level of ongoing Safety Net Provider funding; (4) support to Community Partners for care management, care coordination, assessments, counseling, and navigational services; (5) support to Community Partners for infrastructure and capacity building; and (6) initiatives to scale up statewide infrastructure and workforce capacity to support successful reform implementation. DSRIP funds must be subject to limitations that prevent their use as the non-federal share of claimed Medicaid expenditures. Massachusetts may also claim as allowable expenditures under the demonstration payments for state implementation and robust oversight of the DSRIP program as described below in STC 70(b). DSRIP payments are incentive payments and are therefore not subject to the Safety Net Care Pool Uncompensated Care Cost Limit Protocol.
Delivery System Reform Incentive Program (DSRIP. Section 5.1 Contractor Responsibilities and Reporting Requirements under DSRIP
A. DSRIP Participation Plan The Contractor shall at all times during the Contract Term maintain an EOHHS-approved DSRIP Participation Plan in a form and format specified by EOHHS and as described in this Section.
1. The Contractor’s Preliminary Participation Plan as approved by EOHHS shall satisfy this requirement until the start of Performance Year 1 or as otherwise defined by EOHHS;
2. The Contractor’s DSRIP Plan shall be in a form and format specified by EOHHS and shall provide, at a minimum, the following information:
a. The Contractor’s 5-year business plan, including the Contractor’s goals and identified challenges under this Contract;
b. The providers and organizations (including but not limited to Affiliated Providers) with which the Contractor is partnering or plans to partner for the purposes of this Contract, including descriptions of how these partnerships will support the Contractor’s planned activities and proposed investments under this Contract;
c. A population and community needs assessment, including:
1) The population of Enrollees the Contractor serves and the communities in which they live;
2) The health and functional needs of such population and communities;
3) How the Contractor’s planned activities and proposed investments will promote the health and wellbeing of Enrollees;
4) How the Contractor plans to engage Enrollees and their communities; and
5) The community resources that currently exist for Enrollees, and how the Contractor is partnering or plans to partner with such resources for the purposes of this Contract;
d. As further specified by EOHHS, the Contractor’s planned investments and spending plan, including:
1) Specific investments or programs the Contractor will support with DSRIP funds. Such investments and programs may include but are not limited to:
a) Care coordination or Care Management programs, including any programs to manage high-risk populations or other population health initiatives and including the Contractor’s Transitional Care Management program as described in Section 2.3.C.2;
b) Efforts to address Enrollees’ health-related social needs, including expanding community linkages between the Contractor and providers, CPs, or other social service organizations, and including any spending on allowable Flexible Services to address health-related social needs;
c) Ensuring appropriate workforce capacity and professional development oppor...
Delivery System Reform Incentive Program (DSRIP. The state may claim, as authorized expenditures under the demonstration, up to $1.8 billion (total computable) for five years, performance- based incentive payments to entities that support change in how care is provided to Medicaid beneficiaries through payment and delivery system reforms. DSRIP payments are an incentive for successfully meeting associated metrics and outcomes rather than payment of claims for the provision of medical care. For this reason, DSRIP payments shall not be considered patient care revenue for purposes of offsetting allowable uncompensated care costs under the Safety Net Care Pool Uncompensated Care Cost Limit Protocol under demonstration authority. DSRIP will be a time limited program, and Massachusetts’ efforts undertaken through DSRIP will be sustainable after the demonstration period concludes.
