Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline

A Supplement to the VBP 2019 Reporting Requirements Technical Specifications Manual

  • Presentation is also available in Portable Document Format (PDF)

January 2019

Introduction

  • MLTC plans and providers should review the annual guidance on VBP reporting posted on the New York State (NYS) Department of Health (DOH) website in the VBP Resource Library
    • The document – VBP 2019 Reporting Requirements Technical Specifications Manual – incorporates MLTC and provides quality measure reporting and data file format requirements including the attribution methodology
  • This document – a supplement to the manual – provides a visual timeline for data reporting through December 2020

Acronyms used in the document:

  • PAH denotes the Potentially Avoidable Hospitalizations quality measure
  • VBP QI denotes Value Based Payment Quality Indicators
  • SPARCS denotes Statewide Planning and Research Cooperative System
  • OQPS denotes Office of Quality and Patient Safety
  • MY denotes measurement year

NYSDOH VBP Resource Library is available here.

Key Concepts

  • Attribution – Connects members to providers/ VBP Contractors for the purpose of VBP quality measurement
    • Submitted annually to OQPS in August
    • Covers a 15–month enrollment period to the prior April (15 months is required to capture 3 months of continuous enrollment leading up to the month of July)
    • Attribution files will be used retrospectively for 6 months of prior–year quality measure calculation and prospectively for 6 months of current–year quality measure calculation, crossing 2 measurement years
  • Quality Measures Recommended for Use in VBP
    • Finalized and posted to DOH website in October in the Annual VBP Reporting Manual
    • PAH is calculated by New York State and captures a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection
      • PAH for community members will be calculated based on specific Plan/Provider–VBP Contractor attribution combinations
      • PAH for long–stay nursing home members will be calculated annually by facility
  • Rates and Payment – NYS will use VBP quality results to provide incentives for Plans and VBP Contractors
    • Quality results for MY 2018 will affect 2020–21 rates
    • Quality results for MY 2019 will affect 2021–22 rates
    • Quality results for MY 2020 will affect 2022–23 rates

Timeline Overview

Partially Capitated MLTC plans

MY 2019
  • Plans will submit an attribution file in August 2019 to cover 15 months of plan/provider enrollment (April 2018 – June 2019)
  • Preliminary Community PAH Rates for January – June 2019 data will be released in March 2020
  • Final rates that include data for the January – December 2019 PAH measurement period (for both Community and Nursing Home) and the July 2018 – June 2019 VBP QI will be released in October 2020

MLTC VBP Quality Measure Data Reporting Timeline

Partially Capitated MLTC plans

MLTC VBP Quality Measure Data Reporting Timeline

Please submit all questions to: mltcvbp@health.ny.gov

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