1115 Waiver
On January 9th, 2024, the Centers for Medicare and Medicaid Services (CMS) approved the New York Health Equity Reform (NYHER) 1115 Waiver Amendment. This amendment, which is in effect until March 31, 2027, will allow New York State (NYS) to fundamentally reform the way health care services are delivered through its Medicaid program by fully integrating social care and health care into the fabric of the NYS Medicaid program.
NYS will leverage existing infrastructure of the SHIN-NY and ensure that referral and social care need data will feed into this statewide data repository. Referral platforms/data systems that support screening and referral processes will be qualified and approved by the State to ensure interoperability.
The SHIN-NY will ultimately aggregate screenings & referrals into a single statewide registry, enhance screenings & referrals with better demographics and chronic conditions flags, send extracts where they are needed, namely Medicaid data warehouse and the nine regional lead entities, deliver screening & referral data to point of care, and more.
Recognizing that this program is still in early phases of development, NYeC has shared some initial guidance below. As more information becomes available, we will update and add to these materials. Questions and concerns can be directed to 1115-waiver@nyehealth.org.
1115 Waiver Fast Healthcare Interoperability Resources (FHIR) Implementation Guide
NYeC has developed a FHIR IG to support the exchange of health related-social needs data for the purposes of the New York Health Equity Reform 1115 Waiver Amendment. Throughout 2024, the team has collaborated with the Gravity Project® and Civitas Networks for Health to adopt Gravity Project standards and apply best practices to SHIN-NY 1115 testing. The implementation of this testing has helped to shape the examples, Resource Types, reference data and background all found within this IG. The goal of this guide is to ensure consistent, high-quality data is exchanged from organizations supporting the waiver to QEs and ultimately through the SHIN-NY Data Lake to Medicaid.
This implementation guide was developed to support FHIR from FHIR-enabled information technology (IT) platforms used for this waiver to the Qualified Entity (QE). The Social Care Network Lead Entity (SCN Lead Entity) Request for Applications requires IT platforms to be FHIR enabled within 90 days of contracting (10/31/2024).
IT platforms should be compliant with this IG to be considered FHIR enabled. This IG should be used for all FHIR exchange between waiver supporting organizations, SCN Lead Entities, QEs and the Statewide Health Information Network for New York (SHIN-NY) Data Lake. This IG was built with the guidance, support and dependency on the Gravity Project’s Implementation Guide to directly align with national standards wherever possible.
If you are having trouble accessing the FHIR IG, please email 1115-waiver@nyehealth.org.
Social Care Network (SCN) Operations Manual
Purpose of Manual
The purpose of the SCN Operations Manual is to provide program, billing, and data governance guidance to Social Care Network (SCN) Lead Entities designated by the New York State Department of Health’s (NYS DOH) Office of Health Insurance Programs (OHIP).
This guidance includes requirements governing the delivery of health-related social need (HRSN) services to New York’s Medicaid Fee-For-Service (FFS) and Medicaid Managed Care (MMC) Members, as well as instructions related to data management, data security, and data sharing.
This Manual is a living document
This Operations Manual is a living document and will be updated over time. OHIP will review and refine operational guidance for the SCN program to ensure continued alignment with the State’s aspiration to expand access to high-quality HRSN services. OHIP will publish updated versions of the SCN Operations Manual as they are developed. Please refer to the OHIP website for the latest version of the Manual.
Intended audiences
SCN Lead Entities are the primary audience for this Manual, but some information may be relevant for other audiences including Community-Based Organizations (CBOs) and other HRSN service providers, Managed Care Organizations (MCOs), and health care providers (inclusive of behavioral health and primary care providers).
For more information, please visit the New York State Department of Health Social Care Networks (SCN) Information Page.
Minimum Viable Data Set
NYS has developed a minimum viable data set (MVDS) for waiver support organization to implement. This was developed to ensure that high quality data can be used for CMS reporting. The minimum viable data set is posted here but more details about this data set are also available within the FHIR IG. For access, please email 1115-waiver@nyehealth.org.
Minimum Viable Data Set (MVDS)
Social Care Coding
The terminology in this section contains the systems, codes and displays expected to be utilized for each health-related social needs data type in the 1115 Waiver for reference. For access, please email 1115-waiver@nyehealth.org.
- Social Care Coding
- Screening to Services Mapping (Under Revision)