State Revises Draft Value Based Payment Roadmap

During a Mon., Feb. 23 meeting of the Value Based Payment (VBP) Workgroup, the Department of Health (DOH) reviewed changes made to its draft VBP Roadmap, a document laying out the State’s plan to move Medicaid payments from traditional Fee-for-Service (FFS) methods to alternative payment arrangements such as bundling, risk sharing and capitation.

The State has committed under the Delivery System Reform Incentive Payment (DSRIP) and Fully Integrated Duals Advantage (FIDA) programs to employ alternative payment arrangements. The final VBP Roadmap will be sent to the Centers for Medicare and Medicaid Services (CMS), outlining the Sate’s plan to achieve 90 percent value based reimbursement to providers in the Medicaid program in lieu of traditional FFS within a five-year period. Additional background information on VBP is available here.

Among the major changes made to the draft Roadmap are:

• a revised timeline providing for more meetings of the workgroup and finalization of the document by Wed., April 15, 2015, one month later than originally planned;
• clarification that the Roadmap will be updated annually;
• increased flexibility allowing providers and managed care plans more VBP options;
• revised the requirement for at least 70 percent of payments to be at Level 2 (i.e., “two-sided risk”) by year five to a policy “aim;”
• a VBP innovator program for managed care plans and providers interested in pursuing advanced risk-sharing arrangements; and
• coordination with CMS' plan to tie 90 percent of Medicare payments to quality or value by 2018.  

LeadingAge NY's comment letter on the initial draft Roadmap questioned provider and plan readiness for the aggressive plan; expressed concerns about administrative complexity and regulatory obstacles; and expressed opposition to applying the approach to payers other than Medicaid. While responsive to our request for more time to consider the Roadmap, the above noted revisions did not substantively address LeadingAge NY's basic questions and concerns.

LeadingAge NY has convened a member task force to study and make recommendations on alternative payment arrangements for long term and post-acute care services, as well as provide ongoing feedback on the State’s VBP proposal.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866