CMS Approves VBP Roadmap; Subcommittee Work Begins
In a letter dated July 22, 2015, the Centers for Medicare & Medicaid Services (CMS) approved New York State’s Value Based Payment (VBP) Roadmap, a groundbreaking 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. Meanwhile, the Department of Health (DOH) has convened a series of subcommittees to work out the operational details of implementing VBP in contracts between providers and Medicaid managed care plans.
The final version of the Roadmap reflects language changes to the VBP Level 2 goals that CMS had requested. Level 2 refers to both upside and downside risk shared between managed care plans and providers. The final language is as follows:
“The minimum target for end of DY5 (i.e., 2019) is 35% of total managed care payments (full capitation plans only) tied to Level 2 or higher. In that light, the State will incentivize responsibly, and yearly evaluate this target in the light of progress made toward the overall goals. This minimum target is also subject to change to reflect the need to continue to work towards a higher target should the state exceed expectation due to higher than expected performance. New York will recommend a revised target based on that performance as part of the annual comprehensive review of the roadmap.”
LeadingAge NY members should note that partial capitation plans such as managed long term care (MLTC) plans are excluded from this minimum Level 2 target. Under the Roadmap, 80-90 percent of all managed care payments to providers must also be at VBP Level 1 (i.e., shared savings) or higher by 2019.
The State has convened five subcommittees that are charged with discussing implementation of the VBP Roadmap recommendations. The subcommittees are: (1) Technical Design 1; (2) Technical Design 2; (3) Regulatory Impact; (4) Social Determinants of Health and Community Based Organizations; and (5) Advocacy and Engagement. LeadingAge NY staff and members of our Task Force on Alternative Payment Arrangements are represented on all of the subcommittees. Clinical advisory groups (CAGs) are also being formed, and LeadingAge NY has nominated individuals to the CAG that is considering the MLTC population. We want to ensure that the perspective of long term and post-acute care is provided in the subcommittee process,
So far, the two Technical Design Subcommittees and the Regulatory Impact Subcommittee have met. Technical Design 1 has met twice and has begun discussing attribution, benchmarking and shared savings targets. Regarding attribution, there is some degree of consensus to align with the DSRIP attribution method, which is based on assigned primary care providers. At issue will be the State’s ability to provide meaningful data and guidance on these topics in the short term. Some discussion has also occurred in the exact parameters for minimum shared savings arrangements (i.e., the percentage of upside shared savings in VBP Level 1 and Level 2 if outcome targets are met).
Technical Design 2 began its discussions on preventative services that should be counted as VBP for purposes of meeting the overall targets agreed to with CMS, as well as how the State will be providing technical assistance to providers on VBP arrangements.
The first meeting of the Regulatory Impact Subcommittee focused on regulation of transfers of financial risk from managed care plans to providers. Both Department of Financial Services (DFS) regulations and DOH guidelines require a determination that a provider accepting risk is “financially responsible” or “viable,” and both set forth the circumstances under which the provider must establish a financial security deposit. The group will consider whether existing risk sharing regulations will be appropriate under VBP, weighing the need to protect all stakeholders against destabilizing levels of risk versus the need to avoid excessive or duplicative reserve requirements that divert funds away from service delivery and capital investments. In addition, the subcommittee will be discussing managed care contract changes and the contract approval process, anti-kickback and self-referral laws, prompt payment requirements, fraud and abuse, HIPAA, administrative streamlining, and dispute resolution.
LeadingAge NY will be providing its members with a summary of the final VBP Roadmap in the next several days, and is planning ongoing education on the subject.
Contact: Dan Heim (dheim@leadingageny.org), 518-867-8866