DOH Requires Integrated Medicare-Medicaid MLTC Plans to Convert Contracts to Value-Based Payment

The Department of Health (DOH) has announced that integrated Medicare-Medicaid Managed Long Term Care (MLTC) plans for dual eligibles must convert their provider contracts to value-based payment (VBP) arrangements by March 31, 2018. The requirement applies to Medicaid Advantage Plus (MAP) plans, Fully Integrated Duals Advantage (FIDA) plans, and Programs of All-Inclusive Care for the Elderly (PACE). Although contracts are required to be implemented by March 31, 2018, penalties will be imposed on plans for failure to meet VBP contracting targets based on their percentage of VBP contracts during the period of Jan. 1, 2018 through March 31, 2018. To achieve the target for 2018, 10 percent of plan spending must be included in VBP arrangements. VBP contracts with providers may be effective retroactively to cover this period.

Integrated Medicare-Medicaid MLTC plans will be treated like mainstream managed care plans for purposes of VBP risk levels. Under the State's VBP Roadmap, three risk levels are available:

• Level 1 – Shared savings arrangement with no downside risk;
• Level 2 – Shared savings/shared losses arrangement with limited downside risk; and
• Level 3 – Prospective global capitation payment.

Like mainstream plans, integrated MLTC plans must include in their Level 2 and 3 VBP contracts at least one qualified ("Tier 1") community-based organization (CBO) to implement a social determinant of health (SDH) intervention. Integrated plans have been instructed to consult the VBP Resource Library, under "Social Determinants of Health and Community-Based Organizations," for more information on SDH interventions and implementation.

A guidance document for MAP plans is available here; guidance for FIDA plans is available here; and guidance for PACE programs is available here.

The Department has released for comment two sets of draft quality measures for integrated MLTC plans – one set for MAP and FIDA plans and one set for PACE programs. The MAP and FIDA draft quality measures are available here, and the PACE quality measures are available here.

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