Delivery System Reform Incentive Payment (DSRIP): What You Need to Know about New York’s Changes to Medicaid

DSRIP restructures the current Medicaid delivery system with the ultimate goal of reducing avoidable hospital admissions by 25%.  This is accomplished by putting an emphasis on the use of primary care, and providers using a data sharing system so that all of a person’s providers can share information.  The sharing of this information makes a more comprehensive care model than the old fee-for-service model.  For example, a Medicaid recipient with a chronic illness will likely need to see specialists outside of their primary care physician, which may include a neurologist, oncologist and the like.  The network that these providers are in is referred to as a “Performing Provider System”, or “PPS”.    With this new DSRIP model, these providers will share information on the patient within the PPS.  Information on each PPS and the service areas for each can be found here. 

According to the NYS Department of Health, if you share your information through DSRIP:

• Your providers, across different health care and community settings, should be better able to coordinate and collaborate, and in turn better serve your health care needs.
• You may find that there are new community health services that are easier to use and that meet your needs better.
• You may find that you will need to have fewer tests done since your doctors and hospitals will be communicating better.
• You may receive help from community health workers or care managers. This will help you manage your health and get the care you need.
• People who work for the PPS may reach out to you about special health care services, such as help for your sugar diabetes or high blood pressure.

It is important to note that DSRIP does not change the services!  The plan, providers, and services (including personal care services, as applicable) all remain the same. 

LETTER TO 6 MILLION MEDICAID BENEFICIARIES - On a phased-in basis from September 2015 through August 2016, a letter was sent to  6 million Medicaid beneficiaries giving them information on how to “opt-out” of the data sharing component of DSRIP.  Download a copy of the letter here - including large print and Translations in  8 Languages.  If an individual does not want their information shared, or does participate and later changes their mind, they must contact the DSRIP Medicaid Call Center at (1-855-329-8850) or sign and mail back the "Form to Opt Out of Medicaid Information Sharing” that they received in the mail.  This is called "opting out." Opting out means a person’s protected health information from Medicaid will not be shared with a PPS within the DSRIP program.

More information on opting-out can be found here.  

Opt-Out Process FAQ´s (revised 8-2016)

More DSRIP information:

http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/

Webinar from DOH: DSRIP Debriefing and Mailing to Medicaid Members