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MLTC Clinical Advisory Group Discusses VBP for this Year and Beyond

The Managed Long Term Care (MLTC) Clinical Advisory Group (CAG), on which LeadingAge New York is represented, met on Aug. 17th to discuss Value Based Payment (VBP) for the MLTC population for this year and 2018.  The State is seeking input on VBP quality measures to be used for 2018. You can view the meeting slide deck here

The Department of Health (DOH) clarified that Level 1 VBP for the MLTC population will be a Pay For Performance (P4P) program, which will feature mandatory use of a potentially avoidable hospitalizations (PAH) measure and optional use of other MLTC Quality Measures (QMs). MLTC plans are being required to convert all of their provider contracts to Level 1 P4P contracts by December 31, 2017.  In this regard, all MLTC benefits must be included in P4P arrangements, except for transportation and consumer directed personal assistance services.

MLTC plans will have considerable flexibility in how they structure their contract provisions to meet this requirement. DOH is currently discussing VBP with the management of each MLTC, and will provide more general guidance through a frequently asked questions document.

For purposes of the MLTC QMs for VBP, DOH reminded participants that: (1) plans must be signed up for nightly UAS data exchange; (2) plans and providers can negotiate any type of P4P, but QM improvement over time is the easiest; and (3) MLTC members will be attributed to a primary provider type for purposes of calculating the PAH measure and other QMs; nursing home and home care are the two provider types proposed for attribution. LeadingAge NY strongly advocated for adult day health care to also be considered an attributed provider.

The CAG was also asked to recommend QMs to the VBP Workgroup for 2018 in advance of the Workgroup’s meeting in early Oct.; to examine VBP Level 2 for MLTC; and to provide input on an integrated Medicare-Medicaid VBP strategy for Medicaid Advantage Plus and PACE plans. The CAG had no recommendations during the meeting on additional QMs for 2018, but was invited to provide feedback by Aug. 31st.  There was considerable discussion on how Level 2 VBP would be operationalized in MLTC, as well as on scale and QMs that would apply for integrated duals plans. Further input is sought in these areas as well.

LeadingAge NY will keep members posted on the status of VBP for the MLTC population.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383, ext. 128