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New VBP Specifications and Guidance Released

The Department of Health (DOH) recently released two value-based payment (VBP) resources: an update to the Technical Specifications Manual for VBP reporting and a webinar comparing the VBP requirements of New York State’s Roadmap with the requirements of the MACRA Quality Payment Program (QPP) for eligible clinicians.

2018 VBP Reporting Requirements Technical Specifications Manual

The VBP Reporting Requirements Technical Specifications Manual sets forth the quality measures approved for VBP arrangements under the New York State VBP Roadmap, the changes implemented in 2018, and the reporting requirements for Medicaid managed care plans, including detailed instructions regarding member attribution and quality measure reporting to DOH. These requirements apply to managed long term care (MLTC) plans as well as mainstream plans. The Manual can be found in the DOH VBP Resource Library here.

Webinar on MACRA Alignment with Medicaid VBP

Last week, DOH hosted a webinar describing opportunities to align the Medicare MACRA QPP for physicians and midlevel professionals with arrangements approved under New York’s Medicaid VBP Roadmap. MACRA QPP links physician and midlevel Part B payments to quality based on a set of evidence-based measures. It includes two payment pathways: Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). Clinicians who are subject to MACRA QPP and also participate in Medicare Advantage are likely to pursue contracts with Medicare Advantage plans and integrated Medicare-Medicaid plans in which quality measures are aligned across programs. Moreover, beginning in 2019, the Centers for Medicare and Medicaid Services (CMS) will allow provider-payer contracts under Medicare Advantage, as well as Medicaid managed care and commercial contracts, to be counted in the calculation of a provider’s eligibility for Advanced APM status, which will enable the provider to avoid potential penalties and earn bonuses under the MACRA QPP Advanced APM track. As a result, physician interest in APM-qualified risk-sharing arrangements with Medicare Advantage and integrated plans is likely to grow.

The webinar described ways in which New York’s Medicaid VBP program aligns with MACRA QPP and areas in which there are gaps, including:

  • Certified Electronic Health Record Technology 2015 edition (CEHRT): The MIPS track includes measures focused on patient engagement and use of CEHRT to exchange health information. The New York State VBP Roadmap is silent on CEHRT.
  • Quality Measure Alignment: Under MIPS, clinicians must select at least one outcome measure from six quality measures. The New York State VBP Roadmap requires plans and providers to implement specified outcome measures, some of which align with MIPS.
  • Advanced APM Financial Risk Requirements: To qualify as an “other payer” (e.g., Medicaid, Medicare Advantage, or commercial) APM, a VBP contract must meet specified requirements for “financial risk” which do not fall neatly within New York’s Roadmap requirements.

DOH indicated that it would continue to work with providers and plans to support alignment between MACRA QPP and the Roadmap. Questions can be sent to DOH here.

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