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The 1115 Waiver's four specific technical requirements for SCN lead entities
The New York 1115 Waiver SCN Execution Guide to FHIR Interoperability, Closed Loop Referrals, and HRSN Outcome Reporting
New York's SCNs are operational. The $7.5 billion NYHER program is live. But most regions are still scaling the hard part: FHIR interoperability, closed-loop referral tracking, Gravity Project HRSN data, and equity-stratified outcome reporting for CMS. The 2027 accountability deadline does not move.
Inside This Guide
Your SCN governance is mature. Your data infrastructure is not. The 2027 deadline does not care about the difference.
The nine New York SCN lead entities score approximately 2.8 to 3.0 out of 5 on operational maturity. Governance and service delivery are in place. FHIR interoperability, closed-loop referral tracking, Gravity Project HRSN standardization, and equity-stratified outcome reporting are all still incomplete. This guide covers what needs to be built, why the clock is running, and what purpose-built SCN infrastructure does differently than attempting to build it internally.
What this guide covers
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All nine SCN lead entities profiled: maturity gaps, regional context, and priority needs
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FHIR interoperability at regional network scale: SHIN-NY, HL7v2 conversion, API orchestration
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Closed-loop referrals: why they break at the CBO level and how to fix it across the full network
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Gravity Project HRSN standardization: current adoption gaps and what normalization requires
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CBO digital enablement: tiered integration frameworks for organizations at every tech level
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Equity reporting: what CMS requires and what it takes technically to produce it
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For NY SCN CIOs, Program Directors, and Interoperability Leads.
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Key Takeaways
What SCN program leaders walk away knowing
Why connecting 20 to 50 organizations requires a different approach
A hospital system’s FHIR architecture connects its own systems. An SCN’s architecture connects a region. The design principles, the maintenance model, and the CBO enablement strategy are fundamentally different.
Referral volume is not a program outcome
An SCN that sends 500 referrals per month and cannot demonstrate completion rates has operational activity, not program evidence. CMS requires closed-loop documentation. Learn what the architecture requires.
The Gravity Project gap that breaks HRSN reporting
Incomplete Gravity Project adoption across your CBO and provider network means HRSN data exists but cannot be aggregated. Two years of unstandardized data cannot be used for the program demonstration.
CBOs without FHIR can still close the loop
An interoperability strategy that requires every CBO to have API capability never reaches full network coverage. A tiered integration model with a web portal option brings 100% of your CBO network into closed-loop tracking.
Equity reporting requires data quality you probably do not have yet
Race, ethnicity, and language fields are frequently missing or inconsistently coded across SCN participant organizations. Equity reporting requires data quality remediation at the source, not patching at the reporting layer.
The lead time calculation every SCN leader needs to know
From contract signature to reliable outcome data flowing through the platform is 4 to 6 months. Work backward from your accountability review date. That is when infrastructure decisions need to be made.
Who This Is For
Written for the leaders executing the 1115 Waiver on the ground
CIO and CTO
Responsible for the FHIR architecture, SHIN-NY connectivity, and integration maintenance burden that determines whether the SCN can report to CMS.
VP Population Health
Accountable for HRSN screening rates, referral completion rates, and equity-stratified outcome metrics that CMS will review in the accountability phase.
Director of Social Care Programs
Operationally responsible for CBO relationships, referral workflows, and HRSN data collection across a network with widely varying technical capabilities.
Interoperability Lead
Evaluating FHIR infrastructure options and needs to test real conversion quality against the actual message formats in their network before any commercial commitment.
Test FHIR conversion on your actual SCN data formats today
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