1. SCC Partner Compliance Training Programs
Compliance Program
DSRIP Content for
SCC Partner Compliance Training Programs
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.

2. 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

3. 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.

4. 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

5. 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
SCC

6. 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).

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

8. 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

9. 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 Compliance Program Obligations

10. 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

11. 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

12. 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
Veterans Memorial Highway, Hauppauge NY 11788
Tel: (631) Fax: (631)
Anonymous Hotline:
Anonymous online report:
SCC Compliance and HIPAA Program materials are all online at