DOH Answers Additional Questions on MLTC Value-Based Payment
The Department of Health (DOH) has released answers to questions posed by LeadingAge NY late last year about the State's approach to value-based payment (VBP) arrangements between managed long term care (MLTC) plans and providers. The questions reference a slide presentation provided to MLTC finance staff. Noteworthy information provided by the Department includes the following:
- Will the $50M in VBP quality funding in 2020-21 be allocated based on PAH attributed to both nursing home and home care members?
- DOH will allocate the $50M using a combination of scores from the MLTC Community PAH and the Nursing Home PAH. The scores will be weighted on a plan-by-plan basis according to the proportion of membership a plan has in each care setting.
- What is the measurement period for the Year 1 penalty? First quarter of CY 2018?
- First quarter of 2018: Jan 1, 2018 – March 31, 2018.
- According to slide 9, for Level 1, plans will be measured only on contracting with LHCSAs, CHHAs, and SNFs. Does this mean that under Level 2 arrangements, plans will be measured against payments to other providers? If so, which providers?
- Level 2 arrangements for partially capitated MLTC plans and providers should begin to address the entire continuum of care, including all Medicaid covered services provided by MLTC partial plans. Until such time as Medicare costs can also be included in VBP arrangements for partially capitated MLTC plans, Level 2 arrangements should also reflect a continuing commitment to coordination and cost-control for Medicare services such as acute and primary care as is embodied by the inclusion of the PAH measure. More specific information on Level 2 for partially capitated plans is forthcoming.
The complete set of questions and answers is available here. LeadingAge NY is pursuing clarification of several answers and will update members as more information becomes available.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124