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DOH Finalizes 2018 PACE Value-Based Payment Measure Set

The Department of Health (DOH) has finalized the Value-Based Payment (VBP) Programs of All-Inclusive Care for the Elderly (PACE) Quality Measure Set for Measurement Year 2018. The PACE measures were selected from among the measures under development by the Centers for Medicare and Medicaid Services (CMS) for PACE programs. They were released for comment earlier in the year.

As these measures have not been finalized, DOH has classified them as "pay-for-reporting" or "P4R," rather than "pay-for-performance" or "P4P," in order to incentivize PACE programs to collect and report the necessary data. PACE programs may also contract with downstream providers (e.g., Licensed Home Care Services Agencies (LHCSAs) and Certified Home Health Agencies (CHHAs)) using value-based arrangements. If they enter into VBP contracts with providers, the program and provider may select measures from among the approved PACE-specific measures and the managed long term care (MLTC) measures. According to DOH, PACE programs "qualifying as Level 3 VBP arrangements by virtue of meeting the social determinants of health intervention requirements can choose whether or not to pursue VBP with downstream providers."

The PACE-specific measures are:

  • Percentage of Participants With an Annual Review of Their Advance Directive or Surrogate Decision–Maker
  • Percent of Participants Not in Nursing Homes
  • PACE Participant Emergency Department Utilization Without Hospitalization

Questions may be submitted to DOH here.

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