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DOH Distributes MLTC Quality Incentive Methodology

The Department of Health (DOH) has released the Managed Long Term Care (MLTC) Quality Incentive Methodology for 2020. The metrics are expected to be calculated in the fall of 2020. Satisfaction measures will be based on 2019 satisfaction survey results, quality measures will be based on January through June 2020 Uniform Assessment System (UAS) data, and compliance measures will be based on 2019 measurement year as well as January through June and July through December 2020 UAS submissions. The Potentially Avoidable Hospitalization (PAH) (efficiency) measure will be based on January through December 2019 UAS combined with July through December 2019 Statewide Planning and Research Cooperative System (SPARCS) data.

DOH is updating the codes by which each of the six PAH conditions (congestive heart failure, urinary tract infection, respiratory infection, sepsis, anemia, and electrolyte imbalance) is defined. Instead of using stagnant ICD-10 codes from the Centers for Medicare and Medicaid Services (CMS) demonstration on Nursing Home Value-Based Purchasing, DOH will now use an annually updated set of codes (called a “value set”) to define each of these conditions. The PAH 2020 rate will be based on the value set and not on the ICD-10 codes that were used to calculate earlier PAH rates (e.g., the 2019 and 2017 rates). This will help ensure that the most complete and accurate set of codes is used each year and align with a national standard to define each of the six PAH conditions.

The 2020 methodology document is available here.

Contacts: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 or Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124