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LeadingAge NY Questions Speed and Scope of MLTC VBP Requirements

LeadingAge NY submitted comments on the Department of Health's (DOH) recently announced requirement that partially-capitated managed long term care (MLTC) plans begin to shift provider contracts to value-based payment (VBP) arrangements involving two-sided risk in 2019. To satisfy minimum shared risk requirements, a VBP arrangement will have to involve shared savings and losses in relation to a target budget that incorporates the total cost of all plan benefits. The amount of savings to be shared or losses absorbed will vary based on the provider-contractor's performance on specified quality measures. Plans that fail to meet required levels of VBP contracting will be penalized.

Under the DOH plan, partially-capitated MLTC plans will be penalized unless, by April 1, 2019, at least 5 percent of total MLTC plan expenditures are in two-sided risk arrangements. By April 1, 2020, at least 15 percent of total MLTC expenditures must be in two-sided risk arrangements. Integrated plans that cover both Medicare and Medicaid benefits (e.g., Fully Integrated Duals Advantage plans, Medicaid Advantage Plus plans, and Programs of All-Inclusive Care for the Elderly) are subject to even more aggressive deadlines. At least 10 percent of spending under integrated plans must be captured under shared savings arrangements by April 1, 2018 in order to avoid penalties. By April 1, 2019, at least 50 percent of integrated plan spending must be paid via shared savings arrangements, and at least 15 percent must be paid via two-sided risk arrangements.

DOH expects VBP contracts to be executed with independent provider associations (IPAs), accountable care organizations (ACOs), and individual providers that have the scale, infrastructure, and financial resources to take on risk. In addition, arrangements that involve shared risk must also include contracts to address social determinants of health with community-based organizations that typically do not receive Medicaid reimbursement. We are seeking more information about the types of aging services organizations that would satisfy this requirement.

LeadingAge NY's comments on the DOH plans questioned the speed with which the risk sharing requirements are being rolled out, both for the integrated MLTC plans and the partially-capitated plans. In addition, our comments questioned the availability of ACOs and IPAs in the long-term/post-acute care sector that are willing to take risk for the entire partially-capitated or integrated benefit package. We also noted lack of State investment in MLTC VBP infrastructure, limited stakeholder input, and delays in communicating key information notwithstanding aggressive timelines for implementation.

We noted that many fundamental questions remain unanswered, including the method for calculating target budgets, the percentage of spending attributed to VBP arrangements, and the penalties; exclusions of populations or benefits (if any) from the required VBP arrangements; the inclusion of Consumer Directed Personal Assistance Services in these arrangements; and the payment of PACE programs for new reporting requirements and third-party contract requirements.

More information about the Department's plans for partially-capitated VBP is available here. Information about MLTC VBP generally is available here.

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