New York DSRIP
1115 Quarterly Report
July 1, 2015 – September 30, 2015
Year 1, Second Quarter
November
2015
www.health.ny.gov/dsrip
Office of Health
Insurance Programs
Table of Contents
Introduction .................................................................................................................... 3
Year 1 Focus ................................................................................................................. 3
Summary of Key Accomplishments for the Quarter ................................................... 3
Stakeholder Engagement Activities, Transparency, and Public Forums.................... 4
DSRIP Program Implementation Accomplishments....................................................... 4
DSRIP DY1 First Quarterly Reports/Domain 1 & Project Implementation Plan
Submission and Review ............................................................................................ 4
DSRIP Requests for New York Regulatory Waivers .................................................. 5
Roadmap to Value Based Payments (VBP)............................................................... 5
DSRIP COPA/ACO Application Process ................................................................... 6
Quarterly Expenditures .................................................................................................. 6
Performance Payments ............................................................................................. 6
Other New York State DSRIP Program Activity ............................................................. 6
DSRIP Project Management ...................................................................................... 6
Additional DSRIP Support.......................................................................................... 6
DSRIP Learning Symposium ................................................................................... 10
Upcoming Activities ................................................................................................. 10
Additional Resources ................................................................................................... 11
Attachment A – DSRIP Performance Fund Payments ................................................. 12
2
New York DSRIP
Section 1115 Quarterly Report
Year 1, 2nd Quarter
Introduction
On April 14, 2014 Governor Andrew M. Cuomo announced that New York finalized Special Terms and
Conditions (STCs) with the federal government for a groundbreaking waiver to allow the New York State
Department of Health (DOH) to reinvest $8 billion in federal savings generated by Medicaid Redesign
Team (MRT) reforms. The STCs serve as the governing agreement between DOH and the Centers for
Medicare and Medicaid Services (CMS) under the 1115 Waiver, also known as the Partnership Plan.
The STCs outline the implementation of MRT Waiver Amendment programs, authorized funding sources
and uses, and other requirements.
The waiver amendment programs address critical issues throughout the state and allow for
comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The
DSRIP program promotes community-level collaborations and focuses on system reform, specifically a
goal to achieve a 25 percent reduction in avoidable hospital use over five years. Safety net providers are
required to collaborate to implement innovative projects focusing on system transformation, clinical
improvement and population health improvement. All DSRIP payments are based on performance linked
to achievement of project milestones.
In addition, the STCs commit DOH to comprehensive payment reform and continue New York’s efforts
to effectively manage its Medicaid program within the confines of the Medicaid Global Spending Cap.
Year 1 Focus
This report summarizes the activities from July 1, 2015 through September 30, 2015, the second quarter
of Year 1. This quarterly report includes details pertaining to the second quarter of DSRIP implementation
activities including stakeholder education and engagement, planning and implementation activities, and
development of key DSRIP policies and procedures. A comprehensive DSRIP website was launched on
April 14, 2014 and is available at: www.health.ny.gov/dsrip.
Summary of Key Accomplishments for the Quarter
Highlights of this quarter, which are further described in the report, include:
•
•
•
•
•
Performing Provider Systems (PPS) submitted their DY1 First Quarterly Reports/Domain 1 &
Project Implementation Plan inclusive of revised Domain 1 Implementation Plan and Project
Implementation Plans.
The DSRIP Independent Assessor (IA), the DOH Office of Health Insurance Programs (OHIP),
and DOH partner agencies including the NYS Office of Mental Health (OMH), NYS Office of
Alcoholism and Substance Abuse Services (OASAS), and the NYS Office for People with
Developmental Disabilities (OPWDD) reviewed the First Quarterly Reports/Domain 1 & Project
Implementation Plans, compiled recommendations and submitted feedback to PPS.
The Value Based Payment (VBP) Workgroup, consisting of key stakeholders from various
constituencies around the state, convened to finalize the Roadmap to Value Based Payment in
accordance with CMS feedback. The State received CMS approval of the VBP Roadmap on July
22, 2105.
DOH hosted the First Annual Statewide PPS Learning Symposium September 17-18, 2015 in
Westchester NY.
DOH and its vendors hosted extensive stakeholder engagement activities and public events.
3
Stakeholder Engagement Activities, Transparency, and Public Forums
The period covering July 1, 2015 through September 30, 2015 included extensive stakeholder
engagement activities detailed below:
• July 1, 2015: PPS receive feedback from IA on Domain 1 Implementation Plans
• July 1, 2015: Data collection for D2 & D3 non-claims measures webinar
• July 2, 2015: The Department of Health, the Office of Mental Health, the Office of Alcoholism and
Substance Abuse Services and the Office for People with Developmental Disabilities issued
guidance to Performing Provider Systems (PPSs) interested in seeking Additional Regulatory
Waivers.
• July 7, 2015: Data Security and Information Webinar was released.
• July 9, 2015: Salient Interactive Miner (SIM) New Analyst Training
• July 10, 2015: Domain 2 & 3 non-claims based measures live webinar with Q&A
• July 15, 2015: Domain 2-4 Achievement Values webinar released.
• July 17, 2015: All PPS – Operator assisted call.
• July 22, 2015: PPS Partner Networks posted to website.
• July 22, 2015: CMS approved the Value Based Payment (VBP) Roadmap.
• August 7, 2015: PPS DY1 First Quarterly Report (4/1/15 - 6/30/15) / Domain 1 (revised) & Project
Implementation Plans due from PPS.
• August 14, 2015: Systems Security Plan (SSP) Workbooks email to PPS.
• August 21, 2015: Forestland: Earning Payments Webinar and 5 year Payment model (excel
document).
• September 4, 2015: Partner Contracting Process & Funds Flow Overview by FLPPS webinar was
released.
• September 8, 2015: PPS receive feedback from IA on PPS DY1 First Quarterly Report / Domain
1 and Project Implementation Plans; 15-day Remediation window begins.
• September 10, 2015: Medical Records Review Process Overview Webinar released.
• September 15, 2015: Additional Regulatory Waiver Requests due from PPS.
• September 17 – 18, 2015: First Annual PPS Learning Symposium.
• September 22, 2015: Revised PPS DY1 First Quarterly Report / Domain 1 & Project
Implementation Plans due from PPS; 15-day Remediation window closes.
• September 25, 2015: High Performance Fund Distribution Methodology Live webinar with Q&A.
• September 25, 2015: Workforce Reporting Requirements Live webinar with Q&A.
• September 28, 2015: NYS’s Medicaid Director, Jason Helgerson, hosted a White Board Video
Series “A DSRIP Update” and discussed key DSRIP updates highlighting the Performing Provider
Systems (PPS) shift from planning to implementation, Value Based Payment pilot opportunities,
PPS network additions and the DSRIP midpoint assessment.
• September 30, 2015: Revised Speed and Scale and Reopening of the Performance Network
webinar was released.
For more information visit http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/
DSRIP Program Implementation Accomplishments
DSRIP DY1 First Quarterly Reports/Domain 1 & Project Implementation Plan
Submission and Review
The 25 PPS submitted their DY1 First Quarterly Reports/Domain 1 & Project Implementation Plan on
August 7, 2015 through the MAPP portal. The initial Domain 1 & Project Implementation Plans submitted
by each PPS outline their steps towards the specific DSRIP requirements and projects. The documents
also represent the first PPS quarterly report in which the PPS documented progress on their
implementation efforts through June 30, 2015. The PPS will be required to provide updates on their
progress towards achieving Domain 1 milestones in subsequent Quarterly Reports. PPS will also have
4
the ability to expand upon their initial plans in subsequent Quarterly Reports as their projects evolve
through implementation efforts.
DSRIP Requests for New York Regulatory Waivers – Round 1 recap & Round 2
New York State Public Health Law (PHL) § 2807(20)(e) and (21)(e) authorize the waiver of regulatory
requirements for DSRIP projects and capital projects that are associated with DSRIP projects by the
following agencies:
•
•
•
•
Department of Health (DOH),
Office of Mental Health (OMH),
Office of Alcoholism and Substance Abuse Services (OASAS), and
Office for People With Developmental Disabilities (OPWDD)
Each of the agencies listed above will be engaged in the regulatory waiver process as needed based on
the specific waivers requested.
Following the March 13, 2015 review of requests for regulatory waivers, a total of 101 were approved;
conditional on the receipt of additional information or the completion of further applications.
The primary source of conditional approval was for the request to waive regulations under Mental
Hygiene Law (MHL) Articles 28 (DOH), 31 and 32 (OMH & OASAS), in order to allow the co-location and
integration of primary care, mental health, and behavioral health services. To facilitate this request, DOH,
OMH and OASAS have determined that the requests will be processed through the Licensure Threshold
Model (LTM). OPWDD regulations do not prevent Developmentally Disabled Medicaid members from
receiving services at these locations. Some OPWDD providers are already co-located with
primary/behavioral health providers. Based on the nature of the regulatory waiver requests, OPWDD did
not engage in this round of regulatory waivers.
DOH, OMH and OASAS have established parameters for the LTM and certification of providers offering
services under DSRIP Project 3.a.i Licensure Threshold. In May of 2015, PPS leads were notified of the
availability of the application documents and instructions, which can be found at:
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/regulatory_waivers/draft_appl_instructio
ns.htm
Opening a round two, PPS leads were invited to submit additional Regulatory Waiver requests to DOH
by September 15, 2015. Applications were distributed for DOH program, OMH, OASAS, and OPWDD
review, and responses to these waiver requests are anticipated to go out next quarter.
Roadmap to Value Based Payments (VBP)
A key requirement in the STCs governing DSRIP is the development of the state's Roadmap to VBP. In
support of the state's efforts, over 25 stakeholder interviews were conducted to share preliminary VBP
concepts considered by DOH, to discuss key elements of developing a VBP model, and to request
feedback and suggestions for DOH consideration.
Stakeholders engaged during the interview process included New York State managed care
organizations, representative organizations including the health plan associations, hospital associations,
legal firms specializing in health care contracting, other state agencies, and community based providers,
patient advocates, PPS and other industry experts in VBP. Key themes and challenges identified during
this stakeholder engagement process were documented and reviewed throughout the development
process of the VBP Roadmap.
During this quarter DOH continued to convene the VBP Workgroup, a formal group of stakeholders and
expansion of the Medicaid Reform Team's Global Cap Work Group. The meetings permitted interactive
input into the refinement and finalization of the VBP Roadmap, and the strategic vision for how the state
5
will effectively transition toward a value based payment model for Medicaid reimbursement. DOH
released the VBP Roadmap for public comment on March 2, 2015 for a period of 30 days. DOH
submitted several drafts of the VBP Roadmap to CMS with the final draft submitted to CMS for review
and approval in April 2015. The State received CMS approval of the VBP Roadmap on July 22, 2105.
DSRIP COPA/ACO Application Process
During July 1, 2015 through September 30, 2015, there were no new ACO or COPA applications filed by
DSRIP participating PPS. The state, with technical support from the IA, continued efforts towards making
final determinations on the existing COPA applications by the end of the DSRIP Year 1, Third Quarter.
These efforts included a presentation on market assessment to the New York Attorney General’s Office,
the submission of letters to the COPA applicants regarding requests for additional information or
clarification in support of their application, and the creation of a white paper on requirements for state
action immunity from federal and state antitrust laws.
COPA and ACO certificates of authority may or may not be appropriate, or granted in all cases. If granted,
they are subject to ongoing monitoring. PPS were encouraged to explore all options and contingencies
when designing their DSRIP projects.
Summaries of COPA applications received to date are available at
https://www.health.ny.gov/health_care/medicaid/redesign/copa/docs/copa_application_summaries.pdf,
and information regarding ACO certificates of authority is available at
http://www.health.ny.gov/health_care/medicaid/redesign/aco.
Quarterly Expenditures
Performance Payments
Two DSRIP Performance Fund payments, totaling $96,770,658 (all funds) were made during the period
July 1, 2015 through September 30, 2015. Payments were made on August 24, 2015 to the State
University of New York at Stony Brook University Hospital PPS and the Central New York Care
Collaborative, Inc. PPS. Please see attachment A for all DSRIP Performance Fund payments made during
this quarter and to-date.
Other New York State DSRIP Program Activity
DSRIP Project Management
DSRIP project management efforts were implemented throughout this quarter with the continued use of
the successful MRT process and work plan format, with key DSRIP staff meeting twice weekly and
reporting on DSRIP progress to New York’s Medicaid Director. DSRIP project management meetings
include staff from the IA and the DSRIP Support Team (DST) as well as IT vendors tasked with
developing technology tools in support of DSRIP. Meetings will continue through DSRIP Years 1 – 5.
DOH has established additional, separate project management meetings with the IA and the DST and a
joint meeting involving key staff from DOH, the IA, and the DST. These meetings allow for more in depth
reviews of project deliverables with each vendor and to address any policy considerations requiring New
York DOH input.
Additional DSRIP Support
DOH continues to support the DSRIP program and the 25 PPS through a wide range of activities and
resources. During July 1, 2015 through September 30, 2015, DOH, with assistance from its vendors,
conducted the activities and provided the resources described below.
PPS Data and Performance Management
6
The IA supported DOH in defining DSRIP data and performance management policy and activities
included the following:
•
Created explanatory materials for project valuation and payment materials to address PPS
questions and feedback, including:
o Webinars describing the process of earning Achievement Values (AVs) and payments;
o Examples of AV and payment calculations for a sample PPS called Forestland;
o Webinars and examples describing the process of earning high performance payments;
and
o Data-set creation of all DSRIP measures defined in Attachment J and measure
specification guide to track state performance targets, measure sources, and other
measure characteristics.
•
Assisted DOH in developing guidance for Pay for Reporting (P4R) payments in later DSRIP
years and released to PPS data tables demonstrating distribution of P4R and Pay for
Performance (P4P) AVs across DSRIP years.
•
Supported software development life cycle for MAPP Quarterly Reporting, workforce reporting
specifications, ongoing budget and flow of funds reporting, primary care dashboard
specifications, documentation audit, user roles, and additional MAPP Quarterly Reporting tool
functionality and updates.
•
Created end user training and documentation for MAPP quarterly reporting tool updates.
•
Supported revisions and development of guidance for Measure and Specification Reporting
Manual
Several key decisions were made by DOH including the following:
•
•
•
•
•
High Performance dollars for Tier 1 and Tier 2 will be allocated based on PPS Attribution for
Performance (A4P) and the number of projects applicable to high performance chosen by each
PPS.
High Performance dollars will be distributed across DY2 through DY5 according to a defined
allocation percentage based on the 5-years allocation in the STCs adjusted to the 4-year high
performance period.
To resolve the issue that no measures were available to form the AV basis for P4R payments in
later DSRIP years, DOH established that some measures would be applicable to both P4R and
P4P during applicable payment periods.
Because suitable P4P measures are not available in the 3.g sub-domain until year 4, P4P
payment allocation will be shifted to P4R for the applicable payment periods.
Because Domain 1 measures are reported on a quarterly basis but payments are made on a
semi-annual basis, achievement of milestones and targets will be consolidated from quarterly
reports to semi-annual AVs.
PPS DY1 First Quarterly Reports/Domain 1 & Project Implementation Plan Review
Upon receipt of the 25 PPS DY1 First Quarterly Reports/Domain 1 & Project Implementation Plan in
August, the IA conducted an initial completeness review to ensure all of the required information was
included in the plans. The initial Domain 1 & Project Implementation Plans submitted by each PPS
outline their steps towards the specific DSRIP requirements and projects. The documents also represent
the first PPS quarterly report in which the PPS documented progress on their implementation efforts.
Following the completeness review, the plans were divided amongst a team of IA reviewers who were
responsible for conducting more in-depth reviews and providing feedback on the plans. Additionally, the
plans were reviewed by the DOH OHIP and our state agency partners including OMH, OPH, OASAS
and OPWDD, and their comments were incorporated in the feedback presented to the PPS by the IA.
The reviews began August 8, 2015 and feedback was provided to the PPS on September 8, 2015.
7
These reports will serve as the basis for authorizing and calculating the incentive payments to PPS for
achievement of DSRIP milestones based upon approved DSRIP project plans. The PPS shall have
available for review by New York or CMS, upon request, all supporting data and back-up documentation.
These reports will serve as the basis for authorizing incentive payments to PPS for achievement of
DSRIP milestones. It is anticipated that the final PPS DY1 First Quarterly Reports/Domain 1 & Project
Implementation Plan will be posted to the DSRIP website October 13, 2015.
Validation Protocols
In anticipation of the transition from the planning phase to the implementation phase, the “DSRIP
Reporting and Validation Protocols: Domain 1 Milestones, Minimum Standards for PPS Supporting
Documentation and Independent Assessor Validation Process” were distributed to the PPS on
September 15, 2015 for a two week comment period. Following PPS comment, it is anticipated that a
redline version will be released and an operator assisted call will be hosted to discuss the received
comments. The document is intended to establish minimum standards for PPS milestone completion.
Medicaid Analytics Performance Portal (MAPP)
The Medicaid Analytics Performance Portal (MAPP) is a statewide performance management system
that provide tools and technologies for comprehensive performance management and care management
capabilities to PPS, NYSDOH and other stakeholders. MAPP has been built off the New York Medicaid
data warehouse (MDW) to leverage current system investments in infrastructure, network and its
existing data-rich environment. The MAPP vision focuses on the following three components:
Performance management and analytics: During the DY1 2nd quarter, MAPP’s performance
management functionality teams continue to 1) code and test clinical performance measures, 2)
investigate and develop data analytics and data mining capabilities and 3) prepare for
accurate/actionable/current data feeds into the Salient Dashboard technology that sits within MAPP.
These dashboards were presented and described for CMS in August 2015. The Salient dashboards
allow PPS to review their performance measures and drill down to the member level and to various
accountability layers such as Managed Care plan enrollment, Primary Care Physician and Health
Homes. During this 2nd quarter, security and programming teams met and discussed policies for user
provisioning to access and view summary level vs drill-down member levels of performance.
Care management: MAPP also supports the statewide technology needs for the Health Homes program.
This program is intended to more effectively manage a member’s care with more interoperability care
coordination. During the month of August, Health Homes Phase I system testing and user training
occurred.
Data integration: Data integration involves implementation of a Master Data Management System to
serve as the authoritative, consistent and clean source of master Medicaid data that can be used to
efficiently link data from various data sources. The goal is to provide a more comprehensive view of a
member or a provider. The priority begins with PPS and Health Homes access to more patient
information.
In addition to these focus areas, MAPP continue to offer other statewide capabilities to support the PPS.
MAPP’s current functionality includes an online PPS Provider Network, an online tool to receive and
support PPS quarterly reporting and the ability to calculate complex data sets such as attribution for
performance. Currently there are approximately 250 PPS users and 350 users in total that have been
provisioned to utilize MAPP.
The following is a list of major activities completed by the MAPP team in Q2:
• Deployment of Multi-factor Authentication (MFA) security capabilities for all MAPP users
• Deployment of Implementation Project Plan (IPP) Version 2.0 to support additional functionality
needed for PPS Q2 Submission
• Delivery of updated Speed and Scale counts based on revised Provider categorization logic
8
•
•
•
•
•
Completion of technical specifications and design for DSRIP performance measure calculations
Completion of requirements and design of Salient dashboards
Deployment of DSRIP Digital Library to provide a centralized location for communication sent
from DOH to the PPS
Generation of a PPS Member Roster data file and development of claims extract releases
Development of the parameters for the Medicaid Member mailing DSRIP and opt out notice
MRT Innovation eXchange (MIX)
The MIX was created to centrally manage the development of an interactive public discussion platform
for sharing ideas and insights into the DSRIP program specifically, and Medicaid reform more generally.
This has proven to be a valuable resource for engaging a wide variety of stakeholders in the DSRIP
program. The MIX platform was launched in October 2014. After launch, activities included promoting
the MIX to new users, communicating with existing users, moderating ongoing discussions, and
producing weekly newsletters. From July 1, 2015 – September 30, 2015, the MIX launched a series of
challenges to further involve participants and obtain feedback on various DSRIP initiatives. Challenge
topics included Patient Engagement in DSRIP, Appreciating Social Determinants of Health and Cultural
Competency, and Successful DSRIP Implementation in 2020.
Information Technology (IT) strategy
The DST IT Strategy Team held planning sessions for PPS to increase their understanding of their
current and future IT system requirements. These on-site workshops involved discussions of current IT
architecture, PPS gap assessment, risk matrix, workflow considerations, Regional Health Information
Organization (RHIO) analysis, Health Home project assistance, and a mock-up of IT architecture future
state. The IT Strategy Team continued to support PPS and CIOs through involvement with the MAPP
CIO Steering committee and the related workgroups, and vendor forums through weekly check-ins and
monthly formal meetings. From these meetings, the DST produced participant comment sheets, highlevel vendor requirements, vendor case demonstration scripts, and aids for engaging key stakeholders
throughout the process.
In addition, the IT Target Operating Model (IT TOM) group created blueprints, requirements, scenarios,
and use cases for Projects 2.a.i & 3.a.i to help propel a PPS organizational, technical, and functional
readiness to meet DSRIP goals. This group facilitated weekly workshops at four pilot PPS locations to
help these PPS navigate through technical requirements. These workshops are projected to last until
October 31, 2015.
Medicaid Data Support
The DSRIP Support Team (DST) continued to work with Salient to prepare bookmarks/collections in the
Subscriber Identity Module (SIM) tool that support PPS in their estimations of target populations at the
project level under each domain. PPS also engaged the team to answer data requests that SIM-trained
PPS resources (some PPS employees, other PPS consultants/third parties) sent to a DST monitored
email address.
Direct PPS support
The DST worked to support each PPS by providing tools, analysis, information sessions and day to day
support to assist with the development of PPS DSRIP Implementation Plans. Day to day assistance
included answering DSRIP related questions, clarifying DSRIP documentation and requirements,
providing subject matter support, notifying PPS of upcoming releases, evaluating each PPS
implementation plan approach, providing weekly status reports to DOH on PPS implementation plan
progress and ensuring that PPS are appropriately equipped to meet DSRIP deadlines.
In addition, the DST is planning for a 12-month Medicaid Accelerated eXchange (MAX) series, which is
a learning system that brings together a large number of teams from PPS to seek improvement and
change in a focused topic area. DST deliverables will include topic selection, partnership with at least
9
one external partner per topic, MAX series program design, three MAX face-to-face clinics per topic,
ongoing support to PPS including conference calls, and a summary presentation and publication. It is
anticipated that the first MAX series will be held in October 2015 focusing on the high utilizer population
and will be attended by 5 PPS.
DSRIP Learning Symposium
As outlined in the DSRIP STCs Attachment I, the state is responsible for hosting DSRIP Learning
Collaboratives (Learning Symposium). DOH hosted the First Annual Statewide PPS Learning
Symposium September 17-18, 2015 in Westchester NY. The Learning Symposium was attended by
over 400 key personnel including representation from the state, CMS, PPS and selected members of the
stakeholder community including provider association representation. The focus of the September
Learning Symposium was:
•
•
•
•
•
•
•
Initiate relationship-building discussions within and across Performing Provider Systems (PPSs),
including providers, consumer advocates, and community-based partners
Spur discussion about promising efforts across the state and nation to transform current care
delivery practices
Share implementation strategies and success factors to achieve DSRIP goals
Enhance collaboration within each PPS with broad group of partners
Develop partnerships across PPSs and ways to share emerging best practices and evidencebased approaches
Learn about strategies to improve care transitions and transform delivery systems
Further dialogue between PPSs and NYSDOH about how to achieve DSRIP goals
DOH anticipates hosting multiple PPS Learning Symposiums each year including two regional and one
annual Learning Symposium throughout New York to encourage the sharing of best practices.
More information on the Learning Symposium including the presentations, event agenda and
participation list can be found at the following link:
http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_workshops/september_1718_2015/index.htm
Upcoming Activities
DSRIP Year 1 began on April 1, 2015. Future reports will also include updates on additional activities
as required by the STCs and related attachments. The following list identifies anticipated activities for
the upcoming quarter.
• October 7: Final Approval of PPS DY1 First Quarterly Reports / Domain 1 & Project Implementation
Plans
• October 13: Final PPS DY1 First Quarterly Reports / Domain 1 & Project Implementation Plans
posted to DSRIP Website
• October 22: Phase I DSRIP Notice and Opt out letters mailed to Medicaid members
• October 23: Open PPS Performance Networks in MAPP for edits and additions
• October 31: PPS DY1 Second Quarterly Report (7/1/15 - 9/30/15) due from PPS
• November 9 & 10: DSRIP Project Approval & Oversight Panel Bi-Annual Meeting (upstate PPS)
• November 20: Close PPS Performance Networks in MAPP for edits and additions
• December 1: Independent Assessor provides feedback to PPS on PPS DY1 Second Quarterly
Reports; 15-day Remediation window begins
• December 11: All-PPS meeting
• December 15: Revised PPS DY1 Second Quarterly Report due from PPS; 15-day Remediation
window closes
• December 30: Final Approval of PPS DY1 Second Quarterly Reports
• January 21 & 22: DSRIP Project Approval & Oversight Panel Bi-Annual Meeting (downstate PPS)
10
• Late January: Second Performance DSRIP Payment to PPS
Additional information regarding DSRIP Year 1 key dates can
http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/index.htm
be
found
at:
Additional Resources
More information on the New York State DSRIP Program is available at: www.health.ny.gov/dsrip.
Interested parties can sign up to be notified of DSRIP program developments, release of new materials,
and opportunities for public comment through the Medicaid Redesign Team listserv. Instructions are
available at: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm
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Attachment A – DSRIP Performance Fund Payments
12
New York State Medicaid Redesign Team (MRT) DSRIP Performance Payments Report
Current Report:
Quarter 2: July 1, 2015 - September 30, 2015
Performance Payments
PPS
Public:
Millennium Collaborative Care
Provider
ID
Lead Provider Name
Erie County Medical Center
00245863
DSRIP Total
Payment
Amount
Payment
Date
FFP
Amount
All Other Medicaid Payments Received by the Provider*
Funding Source
(Non-Federal Share)
Base
N/A
$
-
$
-
N/A
$
23,437,840.61
Supplemental
$
-
UPL
VAP
Medical Home
Awards
DSH
$
-
$
-
$
-
ICA
Health Home
$
-
$
2,031,500.00
$
OMIG
Total
-
$
-
$
25,469,340.61
600,361,643.56
246048 / all HHC
N/A
$
-
$
-
N/A
$
302,999,060.56
$
17,656.00
$
-
$
-
$ 201,100,000.00
$
-
$
94,224,919.00
$ 2,013,172.00
$
6,836.00
$
Nassau Queens Performing Provider System, LLC
Nassau University Medical Center
02997368
N/A
$
-
$
-
N/A
$
15,671,316.36
$
2,603.00
$
-
$
-
$
9,867,024.00
$
-
$
5,714,257.00
$
-
$
-
$
State University of New York at Stony Brook
University Hospital
State University of New York at Stony Brook
University Hopsital
03002260
24-Aug
$
51,622,225.00
IGT
$
11,538,172.43
$
-
$
-
$
47,505,453.00
$
-
$
356,133.00
$
-
$
-
$
111,021,983.43
3001723 / 354590
24-Aug
$
45,148,433.00
$
22,574,216.50
IGT
$
15,605,638.48
$
-
$
141,462,305.48
00274213
N/A
$
$
96,770,658.00
$
$ 48,385,329.00
N/A
$
$
3,181,365.11
372,433,393.55
$
$
20,259.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
-
The New York City Health and Hospitals Corporation Jacobi Medical Center
Central New York Care Collaborative, Inc.
SUNY Upstate Syracuse
Westchester Medical Center
Total Public:
Safety Net:
Adirondack Health Institute
Advocate Community Providers
Albany Medical Center Hospital
Alliance for Better Health Care, LLC (Ellis)
Bronx-Lebanon Hospital Center
Finger Lakes PPS
Lutheran Medical Center
Maimonides Medical Center
Mohawk Valley PPS (Bassett)
Montefiore Hudson Valley Collaborative
Mount Sinai Hospitals Group
Refuah Health Center
Samaritan Medical Center
Sisters of Charity Hospital aka Community Partners
of WNY (Catholic Medical Partners)
Westchester Medical Center
Southern Tier Rural Integrated PPS (United)
25,811,112.50
Adirondack Health Institute
Advocate Community Providers, Inc
Albany Medical Center Hospital
Alliance For Better Health Care, LLC
Bronx-Lebanon Hospital Center
Finger Lakes Performing Provider System
NYU Lutheran Medical Center
Maimonides Medical Center
Bassett Medical Center
Montefiore Medical Center
Mount Sinai PPS, LLC
Refuah Community Health Collaborative
Samaritan Medical Center
03449974
04023823
03000364
04025678
00476022
04041594
02996078
02998736
03000593
02998167
04022868
01421705
03001594
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
-
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$
$
$
167,209.37
N/A
13,846,751.63
N/A
62,386,326.10
N/A
26,899,320.26
26,487,125.86
2,572,160.27
128,961,241.10
N/A
5,487,068.99
2,138,162.39
Sisters of Charity Hospital of Buffalo, New York
03001705
N/A
$
-
$
-
N/A
$
28,069,763.72
Southern Tier Rural Integrated Performing
Provider System
04022831
N/A
$
-
$
-
N/A
N/A
$
-
$
-
N/A
N/A
$
-
$
-
N/A
St. Barnabas Hospital (dba SBH Health System)
SBH Health System
00243361
Staten Island Performing Provider System, LLC
Staten Island Performing Provider System, LLC
04021298
The New York and Presbyterian Hospital
The New York and Presbyterian Hospital
The New York Hospital Medical Center of
Queens
00243178
N/A
02998992
N/A
The New York Hospital Medical Center of Queens
$
Total Safety Net:
Grand Totals:
$
$
$
$
96,770,658.00
$
$
$
$
-
N/A
-
N/A
48,385,329.00
$
$
$
$
$
$
N/A
$
44,352,148.97
N/A
$
42,352,419.57
$
14,334,637.95
$
$
398,054,336.18
770,487,729.73
$
-
$ 10,500,000.00
$
$
2,038.00
$
-
$
-
$
$
597,124.88
3,067,853.64
1,418,400.88
2,901,816.56
117,422.02
4,306,818.92
111,314.76
240,721.46
$
$
-
1,320,643.80
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
-
$
-
-
$
$ 102,326,809.00
$
$ 2,013,172.00
$
$
6,836.00
$
$
18,964,612.11
928,535,085.55
$
$
$
$
$
$
$
$
$
$
$
$
$
$
738,559.00
$
$
$
$ 1,104,425.00
$
$
$
$
279,000.00
$
$
$
$
-
$
$
$
$
$
(0.14)
$
$ 48,126.00
$
$
$
9,228.34
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
905,768.37
14,443,876.51
66,558,604.60
28,365,847.14
29,388,942.42
2,968,582.29
133,277,288.36
5,487,068.99
2,249,477.15
28,310,485.76
-
-
$
$
$
$
$
$
$
$
$
$
$
$
$
-
-
-
$
-
$
-
$
0.26
$
-
$
-
$
0.32
$
-
$
-
$
-
$
-
$
-
$
-
$
$
-
$
-
$
-
$
-
$
-
$
-
$
$
-
$
-
$
-
$
-
$
-
$
-
$
$
209,946.00
$
53,296.00
$
-
$
-
2,031,329.26
1,028,146.34
$
$ 17,141,592.52
$ 17,141,592.52
$
$
UPL
80,708,234.00
$ 15,783,247.00
$ 354,963,958.00
$
$
Supplemental
$
-
$
$
$ 10,502,038.00
$ 10,522,297.00
-
$
-
$
31,255,200.36
$
$
-
$
-
$
-
$
$ 354,963,958.00
$
$
0.26
0.26
-
$
-
$
-
$
$ 102,326,809.00
$ 2,331,930.00
$ 4,345,102.00
$ 110,650.52
$ 117,486.52
56,172,792.77
-
$
44,649,028.83
$
15,362,784.29
$
428,140,547.48
$ 1,356,675,633.03
Prior Report:
Quarter 1: April 1, 2015 - June 30, 2015
Performance Payments
PPS
Public:
Millennium Collaborative Care
Payment
Date
00245863
18-May
$
246048 / all HHC
11-Jun
02997368
03002260
18-May
Erie County Medical Center
The New York City Health and Hospitals Corporation Jacobi Medical Center
DSRIP Total
Payment
Amount
Provider
ID
Lead Provider Name
54,571,258.21
FFP
Amount
$
All Other Medicaid Payments Received by the Provider (April - June)*
Funding Source
(Non-Federal Share)
Base
$
VAP
-
IGT
$
11,261,535.31
$
-
$ 333,391,311.76
$ 166,695,655.88
IGT
$
298,823,563.90
$
-
$ 127,489,507.11
$
-
$ 63,744,753.55
$
-
IGT
IGT
$
15,474,425.24
$
-
$
-
$
-
$
-
$
15,442,826.14
$
-
$
-
$
-
$
-
$
14,732,128.00
$
-
$
-
$
-
$
-
$ 599,099,607.00
$
-
$
-
Nassau Queens Performing Provider System, LLC
State University of New York at Stony Brook
University Hospital
Central New York Care Collaborative, Inc.
Nassau University Medical Center
State University of New York at Stony Brook
University Hopsital
SUNY Upstate Syracuse
Westchester Medical Center
Total Public:
Safety Net:
Adirondack Health Institute
Advocate Community Providers
Albany Medical Center Hospital
Alliance for Better Health Care, LLC (Ellis)
Bronx-Lebanon Hospital Center
Finger Lakes PPS
Lutheran Medical Center
Maimonides Medical Center
Mohawk Valley PPS (Bassett)
Montefiore Hudson Valley Collaborative
Mount Sinai Hospitals Group
Refuah Health Center
Samaritan Medical Center
Sisters of Charity Hospital aka Community Partners
of WNY (Catholic Medical Partners)
Westchester Medical Center
00274213
18-May
$ 75,299,136.44
$ 590,751,213.52
$ 37,649,568.22
$ 295,375,606.76
IGT
$
$
5,201,002.19
360,935,480.78
$
$
-
$
$ 599,099,607.00
$
$
Adirondack Health Institute
Advocate Community Providers, Inc
Albany Medical Center Hospital
Alliance For Better Health Care, LLC
Bronx-Lebanon Hospital Center
Finger Lakes Performing Provider System
NYU Lutheran Medical Center
Maimonides Medical Center
Bassett Medical Center
Montefiore Medical Center
Mount Sinai PPS, LLC
Refuah Community Health Collaborative
Samaritan Medical Center
03449974
04023823
03000364
04025678
00476022
04041594
02996078
02998736
03000593
02998167
04022868
01421705
03001594
2-Jun
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
$
$
$
$
$
$
$
$
$
$
$
$
$
16,917,526.21
32,292,614.95
12,728,689.12
22,522,470.13
6,906,676.95
50,721,698.94
6,569,034.40
20,827,139.48
6,402,475.93
11,695,439.45
13,186,101.44
2,041,287.83
7,013,376.57
$
$
$
$
$
$
$
$
$
$
$
$
$
16,917,526.21
32,292,614.95
12,728,689.12
22,522,470.13
6,906,676.95
50,721,698.94
6,569,034.40
20,827,139.48
6,402,475.93
11,695,439.45
13,186,101.44
1,020,643.91
3,506,688.28
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
IGT
IGT
$
$
$
229,670.50
N/A**
16,050,615.86
N/A
49,980,038.48
N/A
33,996,606.23
34,488,736.75
3,107,839.20
120,747,154.33
N/A
4,742,098.99
1,425,235.54
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$ 1,250,000.00
$
$
$
$
$ 4,500,000.00
Sisters of Charity Hospital of Buffalo, New York
03001705
28-May
$
4,122,792.46
$
2,061,396.23
IGT
$
3,706,747.95
$
-
$
$
19,197,656.19
St. Barnabas Hospital (dba SBH Health System)
Southern Tier Rural Integrated Performing
Provider System
SBH Health System
Staten Island Performing Provider System, LLC
The New York and Presbyterian Hospital
Southern Tier Rural Integrated PPS (United)
The New York Hospital Medical Center of Queens
3001723 / 354590
N/A
N/A
$
-
$
-
IGT
$
$
$
$
$
$
04022831
28-May
$
20,295,475.35
$
10,147,737.67
IGT
00243361
28-May
$
16,157,743.35
$
8,078,871.68
IGT
Staten Island Performing Provider System, LLC
04021298
28-May
$
19,852,306.82
$
9,926,153.41
IGT
The New York and Presbyterian Hospital
The New York Hospital Medical Center of
Queens
00243178
28-May
$
4,632,392.78
$
2,316,196.39
IGT
$
49,986,283.42
02998992
28-May
$
1,102,491.23
$
551,245.62
IGT
$
17,145,779.06
$
$
354,804,462.50
715,739,943.28
$
$
Total Safety Net:
Grand Totals
*All other Medicaid payments received by the provider are based on the April 1 - June 30, 2015 time period
Medical Home
Awards
DSH
27,285,629.10
$ 275,987,733.40
$ 866,738,946.92
$ 238,378,800.21
$ 533,754,406.97
N/A
N/A
-
446,076.12
2,287,134.36
1,412,118.12
1,419,074.44
117,061.98
4,287,727.08
110,973.24
239,991.54
$
-
$
-
$
-
$
-
$
2,025,091.74
$
-
$
998,286.66
-
$
$
1,314,793.20
$
-
$ 14,658,328.48
$ 613,757,935.48
-
$
-
$
-
ICA
Total
$
21,226,317.00
$
94,224,919.00
$
670,033.00
$
5,714,257.00
$
828,004.00
$
356,133.00
$
-
$
16,626,963.14
-
$
249,024.00
-
$
-
$
14,981,152.00
$
$ 200,000,000.00
$
$
354,926.00
23,565,458.00
$
$ 102,326,809.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
-
$
536,810.00
3,629,571.00
2,146,347.00
518,984.00
2,702,917.00
113,999.00
65,437.74
$
-
$
-
$
-
$
-
$
$
-
$
$
-
$
-
$
-
$
-
$
$
$ 200,000,000.00
$
$
16,509,009.74
40,074,467.74
-
-
-
$
-
$
-
$
-
$
4,979.00
$
-
$
-
68,101,447.52
2,031,500.00
$
-
$
$
$ 200,000,000.00
$
OMIG
237,154.00
$
$ 5,750,000.00
$ 5,750,000.00
Health Home
$
-
$
$
-
$
$
$
$
$ 31,273.14
$
$
$
$
$ 34,786.66
$
$
$
-
-
$
-
$
4,979.00
7,417.68
$ 1,546,770,697.66
$
149,348,222.35
$
80,855,064.63
$ 1,876,683,547.30
$
$
$
$
$
$
$
$
$
$
$
$
$
$
17,147,196.71
32,292,614.95
29,762,191.10
22,522,470.13
62,834,693.93
50,721,698.94
44,124,105.75
58,503,934.67
9,627,377.11
139,468,024.52
13,186,101.44
6,783,386.82
13,163,584.35
8,142,387.37
$
-
$
-
$
-
$
20,295,475.35
2,661,627.00
$
-
$
-
$
-
$
39,331,819.74
$
-
$
-
$
-
$
-
$
19,852,306.82
$
3,622,504.00
$
-
$
-
$
-
$
60,266,271.94
510,813.00
$
-
$
-
$
-
$
19,757,369.95
$
$ 102,326,809.00
$
$
-
$ 73,477.48
$ 78,456.48
$
667,783,011.60
$ 2,544,466,558.90
Cumulative Report:
Quarter 1&2: April 1, 2015-September 30, 2015
Performance Payments
PPS
Public:
Millennium Collaborative Care
Payment
Date
00245863
18-May
$
246048 / all HHC
11-Jun
$ 333,391,311.76
02997368
18-May
$ 127,489,507.11
03002260
24-Aug
$
51,622,225.00
3001723 / 354590
24-Aug
$
45,148,433.00
$
00274213
18-May
Erie County Medical Center
The New York City Health and Hospitals Corporation Jacobi Medical Center
Nassau Queens Performing Provider System, LLC
State University of New York at Stony Brook
University Hospital
Nassau University Medical Center
State University of New York at Stony Brook
University Hopsital
Central New York Care Collaborative, Inc.
SUNY Upstate Syracuse
Westchester Medical Center
Total Public:
Safety Net:
Adirondack Health Institute
Advocate Community Providers
Albany Medical Center Hospital
Alliance for Better Health Care, LLC (Ellis)
Bronx-Lebanon Hospital Center
Finger Lakes PPS
Lutheran Medical Center
Maimonides Medical Center
Mohawk Valley PPS (Bassett)
Montefiore Hudson Valley Collaborative
Mount Sinai Hospitals Group
Refuah Health Center
Samaritan Medical Center
Sisters of Charity Hospital aka Community Partners
of WNY (Catholic Medical Partners)
Westchester Medical Center
DSRIP Total
Payment
Amount
Provider
ID
Lead Provider Name
54,571,258.21
FFP
Amount
$
All Other Medicaid Payments Received by the Provider (April - September)*
Funding Source
(Non-Federal Share)
IGT
$
34,699,375.92
$ 166,695,655.88
IGT
$
601,822,624.46
$
17,656.00
$
63,744,753.55
IGT
$
31,145,741.60
$
2,603.00
$
25,811,112.50
IGT
$
26,980,998.57
22,574,216.50
IGT
$
30,337,766.48
$ 75,299,136.44
$ 687,521,871.52
$ 37,649,568.22
$ 343,760,935.76
IGT
$
$
8,382,367.30
733,368,874.33
$
20,259.00
$
396,879.87
N/A**
29,897,367.49
N/A
112,366,364.58
N/A
60,895,926.49
60,975,862.61
5,679,999.47
249,708,395.43
N/A
10,229,167.98
3,563,397.93
$
$
$
$
$
$
$
$
$
$
$
$
$
-
Adirondack Health Institute
Advocate Community Providers, Inc
Albany Medical Center Hospital
Alliance For Better Health Care, LLC
Bronx-Lebanon Hospital Center
Finger Lakes Performing Provider System
NYU Lutheran Medical Center
Maimonides Medical Center
Bassett Medical Center
Montefiore Medical Center
Mount Sinai PPS, LLC
Refuah Community Health Collaborative
Samaritan Medical Center
03449974
04023823
03000364
04025678
476022
04041594
02996078
02998736
03000593
02998167
04022868
01421705
03001594
2-Jun
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
28-May
$
$
$
$
$
$
$
$
$
$
$
$
$
16,917,526.21
32,292,614.95
12,728,689.12
22,522,470.13
6,906,676.95
50,721,698.94
6,569,034.40
20,827,139.48
6,402,475.93
11,695,439.45
13,186,101.44
2,041,287.83
7,013,376.57
$
$
$
$
$
$
$
$
$
$
$
$
$
16,917,526.21
32,292,614.95
12,728,689.12
22,522,470.13
6,906,676.95
50,721,698.94
6,569,034.40
20,827,139.48
6,402,475.93
11,695,439.45
13,186,101.44
1,020,643.91
3,506,688.28
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
IGT
IGT
Sisters of Charity Hospital of Buffalo, New York
03001705
28-May
$
4,122,792.46
$
2,061,396.23
IGT
04022831
28-May
$
20,295,475.35
$
10,147,737.67
IGT
00243361
28-May
$
16,157,743.35
$
8,078,871.68
IGT
$
$
31,776,511.67
IGT
$
92,338,702.99
IGT
$
31,480,417.01
Staten Island Performing Provider System, LLC
04021298
28-May
$
19,852,306.82
$
9,926,153.41
IGT
The New York and Presbyterian Hospital
The New York Hospital Medical Center of
Queens
00243178
28-May
$
4,632,392.78
$
2,316,196.39
02998992
28-May
$
1,102,491.23
$
551,245.62
$ 238,378,800.21
$ 582,139,735.97
$
$
$
$
63,549,805.16
The New York and Presbyterian Hospital
$ 275,987,733.40
$ 963,509,604.92
$
$
Staten Island Performing Provider System, LLC
Total Safety Net:
Grand Total:
*All other Medicaid payments received by the provider are based on the April-September 2015 time period.
**N/A is a result of that PPS being a NewCo
$
$
Southern Tier Rural Integrated Performing
Provider System
SBH Health System
The New York Hospital Medical Center of Queens
Supplemental
27,285,629.10
St. Barnabas Hospital (dba SBH Health System)
Southern Tier Rural Integrated PPS (United)
Base
N/A
N/A
$ 752,858,798.68
$ 1,486,227,673.01
$
-
$
-
$ 10,500,000.00
$
$
$
2,038.00
-
$ 10,502,038.00
$ 10,522,297.00
UPL
VAP
DSH
$ 599,099,607.00
$ 599,099,607.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$ 1,250,000.00
$
$
$
$
$ 4,500,000.00
$
$
$
$
1,043,201.00
5,354,988.00
2,830,519.00
4,320,891.00
234,484.00
8,594,546.00
222,288.00
480,713.00
2,635,437.00
-
-
Medical Home Awards
ICA
OMIG
Total
237,154.00
$ 401,100,000.00
$
21,226,317.00
$
9,867,024.00
$
670,033.00
$
11,428,514.00
$
180,603,422.71
$
47,505,453.00
$
828,004.00
$
712,266.00
$
127,648,946.57
$
80,708,234.00
$
249,024.00
$
156,443,457.48
$ 15,783,247.00
$ 554,963,958.00
$
$
354,926.00
23,565,458.00
$
$
$
$
$
$
$
$
$
$
$
$
$
536,810.00
3,629,571.00
2,146,347.00
518,984.00
2,702,917.00
113,999.00
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
$
Health Home
$
4,063,000.00
$ 188,449,838.00
$
$ 2,013,172.00
$
11,815.00
93,570,788.13
$ 2,147,132,341.22
$ 204,653,618.00
$ 2,013,172.00
$ 11,815.00
$
99,819,676.74
$ 2,805,218,632.85
$
$
$
$
$
$
$
$
$
$
$
$
$
$
738,559.00
$
$
$
$ 1,104,425.00
$
$
$
$
279,000.00
$
$
$
$
-
$
$
$
$
$ 31,273.00
$
$ 48,126.00
$
$
$ 44,015.00
$
$
$
-
$
$
$
$
$
$
$
$
$
$
$
$
$
-
18,052,965.08
32,292,614.95
44,206,067.61
22,522,470.13
129,393,298.53
50,721,698.94
72,489,952.89
87,892,877.09
12,595,959.40
272,745,312.88
13,186,101.44
12,270,455.81
15,413,061.50
$
-
$
-
65,438.00
$
-
$
-
$
7,418.00
$
36,452,873.13
$
-
$
-
$
-
$
-
$
-
$
-
$
20,295,475.35
$
-
$
-
$
2,661,627.00
$
-
$
-
$
-
$
95,504,612.51
$
-
$
-
$
-
$
-
$
-
$
-
$
19,852,306.82
$
4,056,421.00
$
-
$
-
$
3,622,504.00
$
-
$
209,946.00
$
53,296.00
$
104,915,300.77
$
2,026,433.00
$
-
$
-
$
510,813.00
$
-
$
-
$
-
$
35,120,154.24
$
$ 554,963,958.00
$
$
16,509,010.00
40,074,468.00
$ 31,799,921.00
$ 630,899,528.00
$ 5,750,000.00
$ 5,750,000.00
$
$ 204,653,618.00
$ 2,331,930.00
$ 4,345,102.00
$ 184,128.00
$ 195,943.00
$ 1,095,923,559.08
$ 3,901,142,191.93