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Managed Long Term Care Quality Work Group Discusses 2018 Measures and Value-Based Payment

The Department of Health (DOH) convened the annual meeting of the Managed Long Term Care (MLTC) Quality Work Group on Nov. 13th. The Work Group provides input into the measures used to evaluate MLTC plans and the methodology for distributing MLTC quality pool dollars. The MLTC quality pool is funded through a 2 percent withhold from MLTC premiums, which is redistributed based on plan performance on specified quality measures. Many of the measures that are used to evaluate the performance of MLTC plans will serve as the basis for value-based payment (VBP) arrangements under the state's Medicaid VBP Roadmap. The Nov. 13th meeting covered proposed changes in measures for 2018 and a discussion of the state's plans for funding VBP contracts for partially-capitated MLTC plans and their network providers. The slides from the meeting are available here, and associated measure documents are available here and here.

DOH intends to make few changes in the quality, efficiency, compliance, and consumer satisfaction measures in 2018. A new falls measure is under consideration based on new questions included in the Community Health Assessment of the Uniform Assessment System (UAS). Rather than evaluating plans on the incidence of falls that require medical attention, the new measure will likely reference falls that result in injury. The existing measure can have the unintended effect of penalizing plans that encourage or arrange for medical attention after falls.

In 2018, DOH intends to add a new compliance measure related to MLTC performance improvement programs. All plans are required to implement performance improvement programs. Under the new measure, plans will be rated on the existence of any statements of deficiency (SODs) related to their performance improvement programs.

The Department is also planning to modify its method for determining which plans qualify for payments from the Quality Pool. In 2018, it will set in advance the scoring thresholds that are used to identify the plans that score high enough to receive payments, rather than setting the thresholds after reviewing the distribution of scores.

Preliminary performance reports for 2017 will be distributed to plans for comment later this month. The distribution methodology document will be released in December, and the quality incentive payments will be finalized in early 2018. The same schedule will be followed in 2018.

In addition to describing the 2018 measures and methodology, the Department announced its intention to commit $10 million in 2017 and $50 million in 2020-21 to VBP under partially-capitated MLTC plans. The initial $10 million will be allocated based on premium revenue and invested in the April 2017 rates, revised for nursing home enrollment. The Department will recoup funding from plans that do not reach the VBP contracting goal of 100 percent by the end of 2017. Each plan will receive a schedule indicating its expected allotment.

The Department is also committing an additional $50 million for VBP performance payments for partially-capitated plans in 2021. The payments will be made based on performance in the 2018 measurement year, which will be reported at the end of calendar year 2019. LeadingAge NY pointed out that guidance from DOH to date has referenced a 2017 measurement year and a 2016 base year for 2018 contracts, at least for home care agency contracts. DOH indicated that a webinar would be made available in the near future to address these and other issues.

In order to support VBP arrangements, DOH has provided plans with 2016 potentially avoidable hospitalization rates by home care agency based on attributed members. Plan that would like to receive home care agency performance data on other quality measures may request those data from DOH. DOH has posted 2016 nursing home potentially avoidable hospitalization rates for long-stay residents on the Open Data website here. Unlike the home care agency data, the nursing home rates are not specific to attributed members. Nursing home performance on other 2016 Nursing Home Quality Initiative (NHQI) measures will be made available in early 2018.

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