New York health regulators have asked the federal government to widen the definition of safety net hospitals and open the doors for thousands of providers to obtain more Medicaid waiver funding.
In a proposal to the CMS, New York state's Department of Health requested a new statewide threshold that would allow independent primary care providers to be designated as safety net providers if they serve more than 25 Medicaid members.
Under the current definition, 35% of a non-hospital provider's clientele must be on Medicaid, uninsured or dual eligible to be considered a safety net provider. New York says that 90% of its Medicaid managed primary care providers don't meet those qualifications. As such, their reimbursements under Medicaid's Delivery System Reform Incentive Payment program—or DSRIP—are limited to 5% of the project's total valuation.
“An estimated 71% of DSRIP participating managed care plan (primary care providers) will be granted SN status under the proposed threshold, thereby covering almost 99% of the Medicaid managed care members enrolled with these DSRIP participating (primary care providers),” the proposal said.
Approximately 7,000 more primary care physicians would become eligible for the safety net designation if the exemption is approved, and the state believes it will create additional financial incentives for physicians to participate in the DSRIP program.
The request comes weeks after the New York legislature passed a bill to redefine safety net hospitals and redistribute funds to those covering the largest Medicaid and medically uninsured populations.