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DOH Proposes New Medicaid Value-Based Payment Model for Nursing Homes

The Department of Health (DOH) has proposed a new model of value-based payment (VBP) for partially-capitated managed long term care (MLTC) plans and nursing homes. The new model would involve the payment of bonuses based on performance on the short-stay discharge to the community quality measure developed by the Centers for Medicare and Medicaid Services (CMS).

Under the State's Medicaid VBP Roadmap, 80 to 90 percent of payments from Medicaid managed care plans to providers must be made via VBP arrangements by 2020. Currently, the approved Level 1 VBP arrangement for contracts between partially-capitated MLTC plans and nursing homes requires payment for performance based on the State's potentially avoidable hospitalization measure. With the enactment of budget legislation this year that limited the nursing home benefit to three months under partially-capitated MLTC, DOH decided to modify the approved quality measure for VBP arrangements between these plans and nursing homes. DOH selected the new measure – 'Percentage of Short-Stay Residents Who Were Successfully Discharged to the Community' – in order to strengthen the incentives for nursing homes to minimize conversions of short-stay residents to long-stay residents.

Very little detail is available on this proposal at this time. DOH has indicated that it will circulate a slide presentation with additional information. LeadingAge NY will be following this proposal closely and will provide updates as information becomes available. Questions and comments may be submitted here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124