DOH Announces Initial QIVAPP Awards

The Department of Health (DOH or the Department) released the details on the first round of Quality Incentive /Vital Access Provider Pool (QIVAPP) Program awards. According to the DOH announcement to the managed care plans (the plans), they are currently allocating the initial $35 million in funding out of the total $70 million pool. The QIVAPP funding pool covers the Program for All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plans (MAP) and single cap Managed Long Term Care Plans (MLTCs).

• Year-End Deadlines: For the plans, there are two critical Dec. 31, 2014 deadlines: 1.) the submission of the attestation form, and 2.) the submission of supporting information and/or license number verifications in cases where DOH has requested further documentation on providers.
  
  The attestation form must be signed and returned to DOH to ensure payment to the plan. The form should be sent to: hcworkerparity@health.state.ny.us, with QIVAPP Attestation indicated in the subject.
  
  All supporting documentation and license number verification should be sent to: hcworkerparity@health.state.ny.us, with QIVAPP Supporting Documentation indicated in the subject line.
  
  For member convenience, the QIVAPP Funding Cover instructions and attestation form are posted on our web page.  For complete details on the program, please refer to the April 23, 2014 QIVAPP Dear Administrator Letter. In this letter, DOH details the criteria for a plan to qualify for payment:
  
  In order for a plan to qualify for payment, they must meet certain pool standards. The plan must also show full compliance with the public health law, including the wage parity statute (§ 3614-c, Home Care Worker Wage Parity). The pool standards include the specific components below:
  
   
• Plans agree to pay a Qualified Incentive Pool Provider (QIPP) a base contracted amount that reflects the cost of investments for home and personal care aide services effective April 1, 2014, and begin such payments for services provided after this date in conjunction with contract payment terms.
   
• A QIPP shall maintain or participate in a specialty training program for home health aides and personal care aides, and shall provide a letter of support for that training program from labor organizations. If a QIPP can demonstrate a specialty training program but cannot obtain a letter of support from a labor organization, the Department will consider exceptions to that element.
   
• The QIPP has a written quality assurance program (already required by DOH regulations) that has been successfully implemented.
   
• The QIPP participates in a health benefit fund for their home health care and/or personal care aides and/or provides comprehensive health insurance coverage to their employees.
   
• MLTC plans provide network survey data to the Department and any other data as needed.
   
• If a provider cannot meet any of these standards, the Department will consider exceptions on a case by case basis, if they can be justified.

The Dear Administrator letter also discusses the calculation of the allocations amounts as follows:

The Department will calculate the current number of QIPP hours based on survey results provided by MLTC plans. The QIVAPP will be divided into a per-hour add-on based upon the hours provided and distributed between April 1, 2014 and March 31, 2015. Such add-on will be passed through by the plans to the QIPP providers. The Department may adjust the amount of the add-on based on subsequent reports of the actual hours provided by QIPPs.

The Department will evaluate managed care rates and the pool structure after no later than October 1, 2014 to determine rate adequacy as well as the need for continuing the pool funding. The QIVAPP funding will be available for services provided up to and including Dec. 31, 2014. Payments will be made over the April 1, 2014 to March 31, 2015 period.

Included in the information just released to the plans are:

1. the funding amount awarded to that plan;
2. the list of contracted home care providers eligible for the initial $35 million award (i.e., the list of currently approved QIPPs);
3. the list of home care providers that are not qualified as meeting the program requirements and/or missing information necessary to qualify; and
4. the attestation form to be completed by the plans confirming that the QIVAPP funding will be passed through to the QIPPs.

Again, this represents an initial award allocation of the first half of the QIVAPP funding. Sometime during the first quarter of calendar year 2015, DOH will complete a final reconciliation of the total $75 million funding pool based on the submission of attestations and additional provider data requests. Once all supporting documentation has been received and reviewed by DOH, a reconciliation of the entire $75 million QIVAPP pool will be done with final payments for plan distribution to approved providers. DOH anticipates making final reconciled awards during the first quarter of calendar year 2015.

Home care provider members with additional questions should contact Cheryl Udell at cudell@leadingageny.org or call 518-867-8871, or please contact me with any questions.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-5527