Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

June 20, 2018

Today´s Agenda

VBP QIP Reminders

VBP QIP Financing – Demonstration Year 3 (DY3) Pairings

VBP QIP SFY 17–18 Pairings & Funding

MCO PPS Facility Gross Funding
Affinity Maimonides Medical Center Brookdale Hospital $31,000,000
Montefiore Hudson Valley Collaborative St. Joseph´s Hospital $7,800,000
Amerigroup Nassau Queens Performing Provider System, LLC Nassau University Medical Center TBD
Advocate Community Partners Jamaica Hospital $16,000,000
Emblem Health (HIP) Health and Hospitals Corp. Health and Hospitals Corp. TBD
Excellus Central New York Collaborative, Inc. Lewis County General Hospital $2,036,000
Finger Lakes Performing Provider Systems, Inc. Orleans Community Hospital $1,434,039
St. James Mercy Hospital $1,844,635
Wyoming County Community Health $1,000,000
Mohawk Valley PPS A O Fox Memorial Hospital $1,000,000
Fidelis Maimonides Medical Center Interfaith Medical Center $50,000,000
Kingsbrook Jewish Medical Center $50,000,000
Montefiore Hudson Valley Collaborative Montefiore–Mount Vernon $11,096,728
Nyack Hospital $17,747,861
Nassau Queens Performing Provider System, LLC St. John´s Episcopal $27,650,000
Westchester Medical Center Bon Secours Charity Health $2,898,070
Good Samaritan Hospital Suffern $2,000,000
Advocate Community Partners Jamaica Hospital $9,000,000
HealthFirst Maimonides Medical Center Brookdale Hospital $109,000,000
MetroPlus Health and Hospitals Corp. Health and Hospitals Corp. TBD
MVP Montefiore Hudson Valley Collaborative Montefiore – New Rochelle $20,837,141
Westchester Medical Center Health Alliance (Benedictine) $2,999,926
United Health Plan Central New York Care Collaborative, Inc. Rome Memorial Hospital $1,000,000
Maimonides Medical Center Wyckoff Heights Medical Center $70,000,000
WellCare Montefiore Hudson Valley Collaborative St. Luke´s Cornwall $19,301,520
Total VBP QIP Funding $455,645,920

* VBP QIP funding amounts do not include premium admin, surplus, or taxes

VBP QIP Program Reminders

As a reminder, contracts are due to the Department of Health on Friday, June 29th.*

Facilities will be penalized if contracts totaling 80% of Medicaid Managed Care dollars are not submitted by this date.

Service exclusion waivers may still be submitted through Wednesday, June 27th.

*Due date is listed as June 29, 2018 since July 1, 2018 falls on a Sunday

VBP QIP P4R – Service Exclusion Waiver

Original Calculation:
Medicaid Managed Care
dollars in VBP arrangement
    _____________________________
Total Medicaid Managed
Care dollars
Calculation with Waiver:
Inpatient & ED Medicaid
Managed Care dollars in VBP arrangement
    _____________________________
Total Inpatient & ED Medicaid
Managed Care dollars








  • Facilities that request the application will be required to:
    • Identify and explain the reason for requesting the waiver*
    • Identify all facilities or organizations with whom they have attempted to partner or will attempt to partner
    • Detail the value of all existing Medicaid Managed Care contracts as well as the value of all Inpatient and Emergency Department services
  • The application review process is expected to take no more than 72 hours

*DOH may require additional reporting by the facility in order to monitor progress towards VBP, ensure sufficient dollars are captured in these VBP arrangements, or determine the level of effort the facility has taken to partner with other local healthcare providers

VBP QIP P4R – Contract Submission Deadline

DOH will now allow facilities to submit contracts without penalty through June 29, 2018* although facilities are encouraged to submit sooner if possible.

If the June 29, 2018 deadline is missed, the same penalty will apply and will be assessed over the remaining 9 months in the Demonstration Year.

With the revised deadline, contracts should have an anticipated effective date of October 1, 2018.

DOH strongly encourages facilities submitting amended contracts to submit by March 31, 2018 so they can have an effective date of July 1 and avoid any gap between contracts. However, amended contracts will be accepted until the June 29, 2018 deadline.

* Due date is listed as June 29, 2018 since July 1, 2018 falls on a Sunday

VBP QIP Contract Attestations

In conjunction with the VBP QIP deliverable to secure 80% of the organization’s Medicaid Managed Care dollars in a Level 1 or higher VBP contract by June 29, the State is asking for an attestation from the facility.      The purpose of the attestation is to:

  • Confirm contracts have been signed and the facility obligation has been satisfied
  • Confirm changes from 2017 letters of intent to what the facility actually contracted in 2018
  • Provide OHIP with a record of the contracts facilities signed in the event a submission from the MCO is delayed or not received

The contract attestation is posted to the website here

Please complete the contract attestation and email by Friday, June 29 to the vbp_qip@health.ny.govmailbox with "VBP QIP – MCO Contract Attestation" in the subject line.

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VBP QIP Contracting

VBP Contract Review

  • Facilities are required to submit Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by June 29, 2018. The facilities should submit information in accordance with the timeline below.
  • Please include "VBP QIP" in the subject line of your contract submissions so they can be easily identified as VBP QIP contracts.
June 29, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review contract@health.ny.gov:
    • Contract Statement and Certification Form
    • MCO assigned unique identifier
    • April 1, 2017 Standard Clauses and the contract must contain the April 1, 2017 Standard Clause Incorporation language
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
 ⇒ August 4, 2018
  • DOH will provide feedback to the contracting MCO, the VBP QIP Facility, and the PPS that either:
    1. Contract is in alignment with the NYS Roadmap and no further updates are needed.
    2. Updates are needed and provide feedback on elements that should be updated to meet roadmap requirements.
 ⇒ August 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
 ⇒ September 28, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO, VBP QIP Facility, and PPS are notified of DOH determination.
  • VBP QIP paired MCO is also notified of DOH determination.

Off–menu contracts may take DOH additional time to review. Therefore, if there are delays in DOH feedback, paired MCOs should continue paying out funds for attestation. The paired MCO can perform a reconciliation in the future if the requirement is not met.

Communication Plan After Contract Submissions

  1. DHPCO sends email to the Plan with remediation, if necessary
  2. The Supplemental Team sends an email to facility and PPS informing them of the remediation
  3. When approved DHPCO sends approval letter to the Plan indicating the contracts can be implemented
  4. The Supplemental Team sends email to facility and PPS that the contract has been approved
  5. Once approved, Plan and facility sign the agreement and return an executed copy to DHPCO

VBP QIP Financing

Payments for P4R and P4P deliverables in VBP QIP will continue to be distributed evenly on a quarterly basis.

  • The delay in the P4R deadline will have no impact on payment distribution.
  • If a penalty is incurred, the State will make any necessary adjustments to the rates in future quarters.
  • In DY4, the P4R requirements are worth 20% of the annual award in DY4, with 5% paid each quarter.
    DY4
      Q1 Q2 Q3 Q4
    VBP Contracting Progress (P4R) % 5% 5% 5% 5%
    Performance Improvement 20% 20% 20% 20%
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VBP QIP Penalty Assessment

Penalty Assessment

For any missed P4R or P4P requirements, penalties will be reflected in the January rate package. However, MCOs have three (3) options when it comes to paying their facilities:

Option 1 Plans may elect to hold (in lump sum) the penalty assessed to the facility from their normal rate payments
Option 2 Plans may elect to keep paying the full funding to the facility and then recover the penalty amount from the facility in knowledge that the State will recover the penalty in a reconciliation of the relative fiscal year.
Option 3 Plans may elect to prorate the penalty over the course of the associated fiscal year.
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VBP QIP Deliverables and Deadlines

Key Deliverable Deadlines

  • Quarterly Improvement will be considered achieved for a measure if the most recently completed quarter´s annual rolling results indicate maintaining or improving the level of quality over the preceding quarter's annual rolling results regardless of the magnitude of improvement.
Measurement Quarter DY3 Q2 DY3 Q3
Measurement Period 10/1/2016 – 9/30/2017 1/1/2017 – 12/31/2017
MCO Reviews Achievement, Prepares Payment March 31, 2018 6/30/2018
MCO Releases Monthly Payments for QIT Achievement Apr – June (2018) Jul – Sep (2018)
MCO Sends P4P Performance Report to DOH July 31, 2018 10/31/2018

VBP QIP Timeline

Description of Event/Task Deadline/Date Completed Responsible Party
Contract Attestations June 29, 2018 Facility
All VBP Contracts with 80% funds in VBP arrangements due to DOH June 29, 2018 Facility
DY4 Q1 measurement period ends June 30, 2018 N/A
Review and approve DY3 Q3 QITs and begin preparing payment June 30, 2018 MCO
Submit QIT Payment report to DOH for DY3Q2 July 31, 2018 MCO
Collect and report DY3 Q4 P4P data to MCO August 31, 2018 Facility
Collect and report DY3 Q4 P4P data to MCO August 31, 2018 Facility
Review and approve DY3 Q4 QITs and begin preparing payment September 30, 2018 MCO

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated contract@health.ny.gov
Remaining contracts due Facilities MCOs & DOH June 29, 2018 contract@health.ny.gov
VBP QIP Contract Attestations Facilities DOH June 29, 2018 vbp_qip@health.ny.gov
Documentation of achievement of P4P metrics Facilities MCOs Quarterly VBP QIP paired MCO
Documentation of approval of P4P deliverables, supporting documentation, and payment date MCOs DOH One month after payment quarter vbp_qip@health.ny.gov
VBP Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated contract@health.ny.gov
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Important Information

VBP Support Materials

VBP Resource Library:
VBP Website:

Thank you for your continued support with VBP QIP!

  • The next VBP QIP Update Webinar is scheduled for September 12th 2018.
  • For questions on VBP QIP quality measures, please email the SPARCS BML at sparcs.submissions@health.ny.gov with "VBP QIP Measures" in the title.
  • For questions on VBP QIP financing, please contact bmcr@health.ny.gov.
  • For other questions on VBP QIP, please contact the VBP QIP inbox at vbp_qip@health.ny.gov.
  • For questions regarding VAP or VAPAP, please contact vapap@health.ny.gov.
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