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LeadingAge NY Comments on Value Based Payment Roadmap

LeadingAge New York’s written comments on the third draft of the State’s Roadmap on Value Based Payment (VBP) expresses general support and recent changes to the Roadmap that will add greater flexibility; stresses that VBP for Long Term and Post-acute Care (LTPAC) should link Medicare and Medicaid; and calls for major efforts to assist providers and managed care plans to prepare for this new payment framework. Previous LeadingAge NY comments on the Roadmap had questioned provider and plan readiness for the aggressive plan and expressed concerns about administrative complexity and regulatory obstacles.

During the Fri., March 13 meeting of the VBP Workgroup, the Department of Health (DOH) reviewed changes made in the third draft of the Roadmap, the document lays out the State’s plan to move Medicaid payments from traditional Fee-for-Service (FFS) methods to alternative payment arrangements such as bundling, risk sharing and capitation.

Among the most recent changes made to the draft Roadmap are:

  • revision of the 90 percent VBP target for DSRIP Year 5 to a more flexible range of 80-90 percent;
  • explicit awareness of the need to enable different categories of providers to proceed at different rates towards the VBP targets;
  • a commitment to treat the Roadmap as a "living document" that will be periodically revisited and modified; and
  • enabling "off-menu" options for providers and plans to develop alternative VBP arrangements that are consistent with VBP policy aims.

The State committed under the Delivery System Reform Incentive Payment (DSRIP) and Fully Integrated Duals Advantage (FIDA) programs to employ alternative payment arrangements. DOH officials signaled their intent to ask the Centers for Medicare and Medicaid Services (CMS) for permission to align the VBP goals and timeframes in FIDA with the DSRIP VBP initiative. The final VBP Roadmap will be sent to CMS outlining the State’s plan to achieve 80-90 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. DOH also posted a white board presentation on VBP by New York’s Medicaid Director, Jason Helgerson.

LeadingAge NY’s Task Force on Alternative Payment Arrangements, comprised of member providers and managed care plans, has been studying and making recommendations on VBP arrangements for LTPAC services, as well as provide ongoing feedback on the State’s VBP Roadmap. The group recently met with lead staff from KPMG, the consultant DOH is using to develop and implement the VBP initiative.

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