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DOH Updates MLTC Clinical Advisory Group

While encouraging Medicaid Advantage Plus (MAP) plans and Programs of All-Inclusive Care for the Elderly (PACE) to maintain their Value-Based Payment (VBP) initiatives, the Department of Health (DOH) indicated that it is not currently imposing penalties on plans that fail to achieve VBP thresholds given the impact of COVID-19 and the expiration of the Delivery System Reform Incentive Payment (DSRIP) Program. The DOH expectations for Partially Capitated Managed Long Term Care (MLTCP) plans are more modest: MLTCPs are encouraged to review their VBP arrangements and make informed determinations whether to renew or expand them. This was a key message from DOH when the MLTC Clinical Advisory Group (CAG) met to review VBP measures for 2021 on Nov. 30th.

While the VBP measure sets and specifications remain basically the same for each plan type as in the prior year, DOH is currently able to calculate only the Potentially Avoidable Hospitalizations (PAH) measure due to the moratorium on in-person reassessments. DOH staff recommended that plans be flexible in their 2021 VBP contracting to accommodate the uncertainty of when performance results for measures other than PAH will become available. MAP plans and PACE organizations were encouraged to continue submitting VBP arrangements based on the State’s established VBP Roadmap. The one measure that is being removed from both the MAP and PACE measurement sets is related to Comprehensive Diabetes Care – Medical Attention for Nephropathy.

In addition to direct communications with plans on Aug. 27th and Sept. 17th announcing that PAH was the only measure currently being calculated, DOH posted a set of Post-DSRIP MLTC VBP Frequently Asked Questions (FAQs) on Nov. 20th. The FAQs note that the principles and standards of the VBP Roadmap remain the same for plans that elect to enter into VBP arrangements. They continue to be governed by the VBP Roadmap and Provider Contract Guidelines, with DOH accepting VBP amendments for review on a rolling basis.

DOH also indicated that the shift from semi-annual to annual assessments will require modifications to the improvement measures. That work is currently underway. Those who wish to provide feedback on the MLTC VBP quality measures for Measurement Year 2021 are asked to do so by Dec. 14th by email to MLTCVBP@health.ny.gov.

LeadingAge NY Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820