Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

September 12, 2018

Today´s Agenda

VBP QIP Financing

VBP QIP Financing

  • Updated Medicaid Managed Care (MMC) Schedule B’s for the April 2018 premiums are now available.
  • These premiums now include updated VBP QIP funding for SFY 2018–2019.
  • These rates have gone live in cycle number 2141.
  • Please contact the Bureau at bmcr@health.ny.govwith any questions.
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Introduction to the Essential Plan Quality Improvement Program (EP QIP)

QIP Updates

  • The intent is to expand VBP QIP into Essential Plan (EP) QIP retroactively to April 1, 2018
  • Once funding has expanded into the EP QIP there will be another Medicaid Managed Care rate package to recoup those dollars distributed
  • Approximately 9.25% of the total QIP funding will be associated with P4R and will continue to be distributed as Medicaid Managed Care funds to fulfill the commitment of moving towards value–based payment in the Medicaid program
  • The P4P requirements will now only exist in EP QIP
  • The expansion to EP QIP will not have an impact on the total DY4 funding amounts for each facility
  • The State QIP Team will be reaching out to all MCOs shortly to set up individual meetings to discuss funds flow

Overview of Programmatic Changes

Roles and Responsibilities

  • Funds will flow directly from the Plans to the EP QIP Facilities. All other roles and responsibilities remain the same in EP QIP.
    • EP QIP funds will be distributed from: DOH → Plan → Facility
    • VBP QIP funds will flow as they always have: DOH → Plan → PPS → Facility

Measure Selection

  • All–Payer quality measures for pay for performance (P4P) evaluation will continue in the EP QIP program.

Flow of Funds

  • For EP QIP, annual awards as determined by the Office of Primary Care and Health System Management will be paid from the Essential Plan. Approximately 9.25% of each facility´s total award will be funded through Medicaid. The remaining portion of each award will be funded from the Essential Plan.

Measure Credits

  • Due to the split of P4R and P4P requirements between VBP QIP and EP QIP, measure credits will not apply in DY4 and DY5.

Measure Selection in EP QIP

Facilities will continue to report on performance measures as in the past.

  • QIT reports will be due on Wednesday, October 31st. Guidance for completing the reports can be found on the QIP Website.

All–Payer quality measures for pay for performance (P4P) evaluation apply in the EP QIP program. Since Essential Plan covers persons between the ages of 19 and 64, alternate measures addressing children’s health issues will be ineligible for EP QIP.

  • Facilities that selected children’s measures as alternate measures as part of VBP QIP will be required choose substitute measures.
  • The facility must select a substitute measure from the same measure focus area/domain (i.e., timely and effective care). Once a measure is selected, the facility must submit a Retired Measure Substitution Form available on the QIP website.
  • Due date to submit the form will be October 31, 2018.

Measure Credit Update

  • Previously, measure credits were made available to facilities that met certain VBP contracting (P4R) milestones
  • Measure credits earned through P4R milestones would be applied as an addition to the numerator for the total number of measures maintained or improved in the facility’s P4P quarterly and annual performance reports
  • Starting in DY4, with the expansion of the program into the Essential Plan, it will no longer be feasible for the state to offer Measure Credits
  • While P4R awards will continue to be funded through Medicaid, P4P awards will now be funded through the Essential Plan
  • Payments cannot be made through the Essential Plan for contracting achievements associated with Medicaid recipients. Therefore, measure credits can no longer be earned through VBP QIP or EP QIP
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VBP QIP Contracting

VBP Contracting

Congratulations to all participating VBP QIP facilities for submitting the necessary VBP contracts to achieve at least 80% of Medicaid Managed Care dollars in VBP arrangements!

DOH received a total of 76 contracts, many of which have been approved

For those contracts yet to be approved please be sure to address any DOH comments by Friday, September 14th

VBP Contract Review

  • Facilities were required to submit Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by June 29, 2018. In accordance with the timeline below, all facilities should hear within next few weeks if the contracts meet program requirements.
June 29, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review
    • 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
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VBP/EP QIP Penalty Assessment

Penalty Assessment

For any missed VBP (P4R) or EP (P4P) QIP 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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EP 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 1/1/2017 – 12/31/2017 4/1/2017 – 3/31/2018
MCO Reviews Achievement, Prepares Payment 6/30/2018 9/30/2018
MCO Releases Monthly Payments for QIT Achievement Jul – Sep (2018) Oct – Dec (2018)
MCO Sends P4P Performance Report to DOH 10/31/2018 1/31/2019

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated
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 Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated
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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 December 12th, 2018.
  • For questions on VBP QIP quality measures, please email the SPARCS BML at with "VBP QIP Measures" in the title.
  • For questions on VBP QIP financing, please contact
  • For other questions on VBP QIP, please contact the VBP QIP inbox at
  • For questions regarding VAP or VAPAP, please contact
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