DOH Submits $17 Billion “HERO” Concept as Waiver Successor to DSRIP

Situation Report | September 7, 2021 

The State Department of Health (DOH) has submitted a concept paper outlining a new 1115 Medicaid Waiver request to the Centers for Medicare and Medicaid Services (CMS) to implement a model dubbed “HERO” as a successor to the expired Delivery System Reform Incentive Payment (DSRIP) program. The proposal seeks $17 billion in funding for New York State. 

The waiver proposal, A Federal-State Partnership to Address Health Disparities Exacerbated by the COVID-19 Pandemicis predicated on 4 pillar components: 

  1. Build a more resilient, flexible and integrated delivery system that reduces racial disparities, promotes health equity and supports the delivery of social care; 
  2. Develop supportive housing and alternatives to institutions for the long-term care population;  
  3. Redesign and strengthen health and behavioral health system capabilities to provide optimal response to future pandemics and natural disasters; and
  4. Create a statewide digital health and telehealth infrastructure. 

Under the Department’s concept, HEROs, or Health Equity Regional Organizations, would be created to regionally plan, organize and foster integration of services, and serve as a basis along with accountable care organizations, social determinant of health networks, community based organizations and managed care organizations to deliver value based services and work to address health disparities and health equity. 

Additional components involve linkage of long term care services and housing, investment in the workforce, creation of a Virtual Access Fund (supporting telehealth and technology), behavioral health integration, and services for individuals in the criminal justice system. 

HCA will be engaging the full membership in the analysis of this proposal and its implications for the home and community-based sector, patients, and the health system overall. HCA has worked at multiple levels to support system integration, improved quality and access, collaborative models of care, and efficiency. The Association has also been extremely prominent with legislative, budget, educational and program proposals to combat health disparities through home care’s unique positioning in the health care system. HCA will be seeking to maximize input in shaping this or any further iteration of this proposal and welcomes the opportunity to work with state officials in crafting an effective and responsive initiative and investment for New York’s health care system.