SCC Partner Compliance Training Progams Compliance Program DSRIP Content for SCC Partner Compliance Training Progams This module is intended to provide DSRIP-specific information to hubs and partners to supplement their own existing compliance programs. It may be adapted for educational use. It is not intended as legal advice and is not guaranteed or warrantied.

Based on this presentation materials, participants will be able to: Learning objectives Based on this presentation materials, participants will be able to: Know that their organization’s Compliance Program also includes DSRIP-related expectations Know what DSRIP and the SCC are Understand their organization’s participation in DSRIP projects Know how to report fraud, waste and abuse involving Medicaid funds or the DSRIP program 1

Each PPS is a network of providers engaged in DSRIP projects. introduction The Delivery System Incentive Reform Payment program (DSRIP) is a joint federal-state initiative made possible by a “1115 waiver” from the federal Centers for Medicare and Medicaid. The waiver allows for innovations to be tried and assessed for effectiveness. Administered by NYS Dept. of Health, DSRIP involves 5-year grants to 25 Performing Provider Systems (PPSs) across NY to change the way Medicaid works. Each PPS is a network of providers engaged in DSRIP projects.

Each provider is identified with a hub Hub model Your organization is a partner in the Suffolk Care Collaborative (SCC), the only PPS in Suffolk County. SCC is organized with hundreds of providers assigned to one of 3 “hubs”: Stony Brook Medicine Northwell Health Catholic Health Services Each provider is identified with a hub Each Medicaid patient is attributed to a provider/hub

The transformative goals of DSRIP and SCC are to: Dsrip goals The transformative goals of DSRIP and SCC are to: Improve access to care for Medicaid and uninsured patients Improve quality of care and health outcomes Lower costs Reduce avoidable hospital and emergency department use by 25% Change Medicaid payment model from fee-for-service to pay-for-performance You can learn more about DSRIP and SCC online: DSRIP http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ SCC https://suffolkcare.org

DSRIP and its projects Partners receive payment for successful participation in one or more of 11 DSRIP Projects. Each project has healthcare and/or organizational goals. Your organization is participating in the projects listed on the next slide(s).

Projects list [Partner, please insert the Projects in which you participate on this slide – create more slides if necessary]

How is your organization paid? SCC functions as a central service organization for the entire PPS and administrators the lead hub (Stony Brook) In response to requests from DOH/SCC, Partners submit reports on projects to SCC SCC prepares reports as claims for payment and submits them to DOH After Independent Assessor and other review, DOH issues funds to SCC SCC distributes funds to Partners shares on Funds Flow plan

DSRIP COMPLIANCE FOCUS Our Compliance Program focuses on data integrity because DSRIP payments are made based on reports (data collections) from Partners We expect Partners to implement Quality Assurance/ Control measures into their reporting processes to ensure accuracy and completeness Our Participation Agreement Exhibit G includes: 1.3 Truthful Reporting 5 Audits 6 Record Retention 7 Compliance Program Obligations

Partners are responsible for: Implementing regulatory compliance in their operations: training, policies and procedures, hotline, etc. A Code of Conduct and individual certification Conducting timely restricted party screening Reporting to the SCC Compliance Officer DSRIP-related noncompliance issues, fraud, waste or abuse in a timely manner Cooperating with the SCC Compliance Program in investigations and corrective actions involving their organization Cooperating with audits by the SCC and government

Partners are also responsible for ensuring: Accuracy and completeness of all reports to the SCC, including reports such as patient engagement data, performance metrics, financial information, etc. That they have adequate controls in place to prevent and detect fraud, waste and abuse Appropriate documentation and record retention of DSRIP-related compliance program activities All other contractual terms in the SCC Participation Agreement are met

SCC Compliance and HIPAA Program materials are all online at DSRIP Compliance Reporting & contact information For more information, or to report DSRIP noncompliance, contact your Compliance Officer or the SCC Compliance Officer at 1383-8 Veterans Memorial Highway, Hauppauge NY 11788 Tel: (631) 638-1773 Fax: (631) 639-1009 SCC-Compliance@stonybrookmedicine.edu Anonymous Hotline: 1-844-599-8785 Anonymous online report: http://suffolkcare.ethicspoint.com/ SCC Compliance and HIPAA Program materials are all online at https://suffolkcare.org/compliance