Value Based Payment Level 1 Health Plan Amendments

Deanna Stephenson in Managed Care

DOH has implemented a December 31st deadline for Managed Long Term Care Plans (MLTCs) to partner with nursing facilities on VBP Level 1 contract amendments. NYSHFA / NYSCAL has responded to DOH regarding contract changes (see attached letter). NYSHFA / NYSCAL is recommending that providers please read each amendment in detail and follow the VBP Level 1 MLTC Arrangement Contract Checklist endorsed and distributed by DOH. Please see below for contract checklist. 

  • Does the contract match the Roadmap arrangement definition (Do you see MLTC Level 1 P4P in contract)?
  • Does the contract specify the VBP Contractor and the services to be included in the arrangement (Does it state SNF)?
  • Does the contract commit to using the Category 1 PAH (potentially avoidable hospitalization) measure as a P4P (pay for performance) measure?
  • Does the contract contain performance targets/benchmarks to be used for P4P (e.g., Less than 2.0 members to avoid potential hospitalization)?
  • Does the contract specify a timeframe for measurement and payment?
  • Are other Category 1 and 2 measures to be used in the agreement specified and targets identified?
  • Does the contract specify a method for awarding and distributing performance payments? (Does it spell out how you will receive bonus payment, when you will receive bonus payment and how much will that bonus payment will be.)
  • Does the contract describe the attributed population and method of attribution? (Is the attribution number spelled out and does the amendment tell you how the attribution number was created?) 

If you have received an amendment from a MLTC and have questions regarding above or feel the amendment does not cover some of the details listed please reach out to The DOH VBP Team at mltcvbp@health.ny.gov.

NYSHFA/NYSCAL CONTACT:

Deanna L. Stephenson
Director, Managed Programs
518-462-4800 x16