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VBP Measures for PACE and MAP Plans to Resume in 2023

At a meeting of the Managed Long Term Care Value-Based Payment Clinical Advisory Group (MLTC CAG) on Jan. 10, 2023, the Department of Health (DOH) announced that it would resume calculation of quality measures to support value-based payment (VBP) arrangements in the integrated Medicare and Medicaid managed care plans (i.e., Programs of All-Inclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP)). Calculation of the VBP measures had been suspended as a result of the COVID-19 pandemic. The Potentially Avoidable Hospitalization measure was calculated for measurement year 2021 and released in 2022. DOH will resume calculation of the remaining Category 1 VBP measures for PACE and MAP plans in 2023. As indicated in the VBP Roadmap, DOH will no longer calculate measures to support VBP arrangements for partially capitated MLTC plans.

Beginning in measurement year 2022, VBP quality measures will be calculated on an annual, rather than semi-annual, basis. The measurement period will be the calendar year. Results will be released in the third quarter of the following calendar year.

The measure sets remain unchanged for both PACE and MAP plans. All Uniform Assessment System (UAS)-based Category 1 measures will be calculated for the 2023 measurement year. As in the past, calculations will be based on attribution files submitted by the plans that link enrollees to VBP contractors. Plans and their VBP-contracted providers may select among the approved measures for purposes of their VBP contracts. For measures that involve a member's status in the last 90 days, DOH will use the last assessment for the member in the relevant calendar year. For those measures that involve stability or improvement, the measurement approach will be modified and disseminated in a methodology document to be released in the near future.

The 2023 measure set and VBP reporting specifications will be released this month. Questions and feedback may be submitted to DOH at mltcvbp@health.ny.gov. Slides from the CAG meeting are not yet available, but will be posted here once they are released.

Contact: Karen Lipson, klipson@leadingageny.org