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MLTC Value-Based Payment Clinical Advisory Group Meets

The Department of Health's Managed Long Term Care (MLTC) Clinical Advisory Group (CAG) met on April 18th to discuss proposed Value-Based Payment (VBP) models for MLTC plans and providers. Under the State's Delivery System Reform Incentive Payment (DSRIP) program waiver, 80 to 90 percent of all payments from Medicaid managed care plans to providers must be made via VBP arrangements by 2020. For MLTC plans and their network providers, these arrangements may include pay-for-performance in connection with reductions in avoidable hospitalizations, shared savings arrangements, two-sided risk arrangements, and subcapitation arrangements. The CAG is charged with advising the Department on the structure of MLTC VBP models and the quality measures to be used to assess performance under these arrangements. 

This week's CAG meeting was the final meeting prior to the release of recommendations to the Department's VBP Workgroup and final revisions to the 2016 VBP Roadmap Update. The CAG reviewed proposed VBP models for MLTC beneficiaries residing in nursing homes and in the community, various quality measures that could be used to evaluate performance under these arrangements, and regulatory reforms needed to facilitate implementation of VBP arrangements. 

The Department and its consultants from KPMG announced at the meeting that they are soliciting proposals from MLTC plans and providers for pilot VBP projects. Pilot project participants will be eligible for technical assistance, data, enhanced administrative payments and participation bonuses for plans, and performance and stimulus adjustments for providers. Pilot project participants must have some experience with VBP and must be able to cover a large number of beneficiaries under the proposed arrangement. The Department and KPMG will begin convening MLTC pilot project participants this summer, with a goal of launching pilots in early 2017. Plans and providers interested in conducting a VBP pilot are encouraged to submit their ideas to the MLTC VBP team at KPMG. LeadingAge New York staff will provide contact information for the KPMG team upon request.

LeadingAge NY staff and members have been participating in the VBP Workgroup, Subcommittees and MLTC CAG. In addition, we have submitted written comments to the CAG on MLTC models and regulatory reforms and comments on the VBP Roadmap Update

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