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Discussions Begin on Medicaid Value Based Payments

With upcoming federal expectations for New York to move Medicaid payments from traditional Fee-for-Service (FFS) methods to alternative payment arrangements, the Department of Health (DOH) officially convened the Value Based Payment (VBP) Workgroup in Albany on Fri., Jan. 23. Meanwhile, LeadingAge New York is planning to convene a member task force on alternative payment arrangements to research and make recommendations on this complex subject. The State has committed under the Delivery System Reform Incentive Payment (DSRIP) and Fully Integrated Duals Advantage (FIDA) programs to employ alternative payment arrangements.

The DOH workgroup, on which LeadingAge NY is represented, discussed the initial draft of the "Value Based Roadmap," a document the State plans to send to the Centers for Medicare and Medicaid Services (CMS) this March, outlining its plan to achieve 90 percent value based reimbursement to providers in the Medicaid program in lieu of traditional FFS within a five-year period. Additional background information on VBP is available here.

The plan in the first draft of the Roadmap is aggressive, proposing that: (1) at least 50 percent of Medicaid reimbursement by managed care plans to providers be at VBP “Level 1,” with at least 30 percent at “Level 2” by Year 4; and (2) at least 90 percent of payments at VBP Level 1 by Year 5, with at least 70 percent at Level 2.

The Roadmap defines Level 1 payments as “FFS payment with upside-only shared savings available when outcome scores are sufficient,” while Level 2 payments are “FFS with risk sharing (upside available when outcomes scores are sufficient; downside is reduced when outcome scores are high).” There is a Level 3 for experienced providers that are capable of risk management, which would involve “…prospective capitation PMPM or bundle (with outcome-based component).” During the discussion, both plans and providers urged DOH to remain flexible on the timeframes, penetration levels and levels of risk sharing that would apply under the plan.

LeadingAge NY and other workgroup members were asked to provide feedback on the draft Roadmap by Fri., Jan. 30. DOH plans to make revisions and submit the first draft to CMS by Wed., Feb. 4, and make the Roadmap available for public comment at the time. The second VBP meeting will take place Tues., Feb. 24. The State plans to submit the final Roadmap to CMS in March and hopes to secure CMS approval by Wed., April 1, 2015 - the start of DSRIP Year 1.

LeadingAge NY is welcoming feedback from members on the draft DOH VBP Roadmap document. We are also convening a member task force to study and make recommendations on alternative payment arrangements for long term and post-acute care services, as well as provide feedback on the State’s VBP proposal.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866