Programs of All-Inclusive Care for the Elderly

Value Based Payment Quality Measure Set
Measurement Year 2022

  • Measure Set also available in Portable Document Format (PDF)

May 2022                                                         NYS Medicaid Value Based Payment

Please note: Due to COVID-19 and the Department's suspension of Community Health Assessments for of MLTC enrollees reassessment until July 2021, the calculation of the MLTC VBP Category 1 measures, except for the Potentially Avoidable Hospitalization (PAH) measure, may be impacted for 2022.

The measurement year (MY) 2022 value based payment (VBP) quality measure set for Programs of All-Inclusive Care for the Elderly (PACE) was created in collaboration with the Managed Long Term Care (MLTC) Clinical Advisory Group (CAG), a Sub-team empaneled by the CAG to discuss VBP approaches and quality measures for Medicaid Advantage Plus (MAP), Programs of All-Inclusive Care for the Elderly (PACE).

The PACE-specific measures in Table 1 have been selected from Streams 2 and 3 of the PACE measures currently under development with the Centers for Medicare and Medicaid Services (CMS). To reflect the developmental nature of the measures the recommended classification for these measures for MY 2022 is P4R to incentivize appropriate data collection and establish measure use. PACE Organizations will be required to report on these measures for the PACE. If a PACE chooses to contract with a downstream provider for VBP, measure selection is at the discretion of the plan and provider. PACE Organizations qualifying as Level 3 VBP arrangements by virtue of meeting the social determinants of health intervention requirements can choose whether to pursue VBP with downstream providers.

In addition to the measures listed in Table 1, Table 2 lists the recommended Category 1 and Category 2 VBP measures for PACE plans for MY 2022, if a PACE chooses to contract with any of its downstream providers. The Table 2 Category 1 measures are considered valid and feasible for use . Category 2 measures, listed in Table 3, are also considered valid but may warrant additional implementation effort stemming from feasibility issues.

MEASURE CLASSIFICATION

Based on Sub-team recommendations and feedback from MAP Plans and PACE Organizations, the State developed quality measure sets specific to MAP and PACE to reflect the unique components of these plans. The measures specifically recommended for use by PACE Organizations are listed in Table 1.

Category 1

Category 1 quality measures as identified by the MLTC CAG and accepted by the State are determined to be clinically relevant, reliable and valid, and also feasible for use by VBP Contractors. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.1

The State has further classified each Category 1 measure as either P4P or P4R:

  • P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
  • P4R measures are intended to be used by MLTC plans to incentivize VBP Contractors to report data on the quality of care delivered to members under a VBP contract. Incentive payments for reporting will be based on the timeliness, accuracy, and completeness of data submitted. Measures can be reclassified from P4R to P4P through annual CAG and State review, or by the MLTC plan and VBP Contractor.

Category 2

Category 2 measures have been accepted by the State based on agreement of measure importance, validity, and reliability, but present implementation feasibility concerns. These measures will be further investigated with VBP program participants.

MEASUREMENT YEAR 2022 MEASURE SET

The measures and classifications provided on the following pages are recommendations for MY 2022. Note that measure classification is a State recommendation. Plans and VBP Contractors may use measures as P4R or P4P per the terms of their individual contracts.

Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include additions, deletions, reclassification of measure category, and reclassification from P4R to P4P based on experience with measure implementation in the prior year. During 2022, the CAGs and the VBP Workgroup may re-evaluate measures and provide recommendations for MY 2022.

VBP Quality Measures Specific to PACE Organizations

Table 1 displays the quality measures specific to PACE Organizations and includes measure title, measure steward, and State determined classification for measure use. All PACE-specific measures recommended for use in MLTC VBP for PACE Organizations are classified as P4R for MY 2022. The P4R measures shown in Table 1 must be reported to the State by PACE plans for the PACE.

Table 1: VBP Quality Measures for Specific to PACE
Measures Measure Source/ Steward Measure Identifier Classification
Percentage of Participants with an Advance Directive or Surrogate Decision Maker AND Percentage of Participants With an Annual Review of Their Advance Directive or Surrogate Decision-Maker Document CMS -- P4R
Percent of Participants Not in Nursing Homes CMS -- P4R
PACE Participant Emergency Department Utilization Without Hospitalization CMS - P4R

Acronym: CMS denotes the Centers for Medicare and Medicaid Services

Category 1: VBP Quality Measures PACE Organizations

Table 2 displays the complete Category 1 MLTC VBP Measure Set for PACE Organizations and includes measure title, measure steward and/or other measure identifier (where applicable), and State determined classification for measure use. All Category 1 measures recommended for use in MLTC VBP for PACE Organizations are classified as P4P for MY 2022.

Table 2: Category 1 VBP Quality Measures for MAP and PACE
Measures Measure Source/ Steward Classification
Percentage of members who did not have an emergency room visit in the last 90 days UAS - NY/New York State P4P
Percentage of members who did not experience falls that resulted in major or minor injury in the last 90 days UAS - NY/ New York State P4P
Percentage of members who received an influenza vaccination in the last year * UAS - NY/ New York State P4P
Percentage of members who did not experience uncontrolled pain UAS - NY/ New York State P4P
Percentage of members who were not lonely or not distressed UAS - NY/ New York State P4P
Potentially Avoidable Hospitalizations (PAH) for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection UAS - NY/ New York State with linkage to SPARCS data P4P

* Included in the NYS DOH MLTC Quality Incentive measure set
Acronyms: UAS - NY denotes the Uniform Assessment System for New York for MLTC members; SPARCS denotes the Statewide Planning and Research Cooperative Syste.

Category 2: VBP Quality Measures for PACE Organizations

Table 3 displays the complete Category 2 MLTC VBP Measure set and includes measure title, measure steward and/or other measure identifier (where applicable), and the recommended measure use classification.

Table 3: Category 2 VBP Quality Measures for MAP and PACE
Measures Measure Source/ Steward Classification
Care for Older Adults - Medication Review NCQA P4R
Use of High-Risk Medications in the Elderly NCQA P4R
Percentage of members who rated the quality of home health aide or personal care aide services within the last 6 months as good or excellent* MLTC
Survey/New York State		 P4R
Percentage of members who responded that they were usually or always involved in making decisions about their plan of care* MLTC
Survey/New York State		 P4R
Percentage of members who reported that within the last 6 months the home health aide or personal care aide services were always or usually on time* MLTC
Survey/New York State		 P4R

* Included in the NYS DOH MLTC Quality Incentive measure set
Acronyms: NCQA denotes the National Committee for Quality Assurance

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1. New York State Department of Health, Medicaid Redesign Team, A Path toward Value Based Payment: Annual Update, December 2021 (Link)  1