DOH Announces Slight Changes in MLTC Plan Quality Measures

At the annual meeting of the Managed Long Term Care (MLTC) Plan Quality Work Group held last week, the Department of Health (DOH) announced modest changes in the quality measures that are used to evaluate MLTC plan performance and determine distributions from the MLTC Quality Incentive pool. The changes affect both the 2019 and 2020 Quality Incentive measures. The slides from the meeting are available here.

The changes in the measures for 2019 are:

• The 'percentage of members with no emergency room visit in the past 90 days' quality measure, which was suspended for 2018, will be restored for 2019; and
• The compliance measure related to the alignment of encounter data spending with cost report medical expenditures will be suspended because the data are not ready.

The potentially avoidable hospitalization (PAH) efficiency measure will remain the same. However, the measure will be calculated based on July through December 2018 Statewide Planning and Research Cooperative System (SPARCS) data and April through December 2018 Community Health Assessment (CHA) data. The SPARCS program is undergoing a data processing remediation which may delay the calculation of the PAH measure. The remediation should be complete by early 2020.

The proposed changes for 2020 are:

• The encounter data reported spending compliance measure that was suspended for 2019 will be restored;
• A new compliance measure will be added pertaining to meeting deadlines for performance improvement plans;
• The measurement periods for calculating the incomplete assessment compliance measure will be expanded to include both July through December 2019 and January through June 2020; and
• Diagnosis codes used to identify PAHs will be updated to reflect changes in coding practices. The same six diagnosis categories will be used.

July through December 2018 MLTC Quality data are available on Health Data NY. January through June 2019 data should be available in early 2020. The measures are available here, and the benchmarks are here.

DOH is interested in receiving feedback on the 2020 changes and input into the quality measurement process for MLTC plans, which can be provided directly or through the associations. The Department expects to distribute 2019 plan-specific results in early 2020 and 2020 results in early 2021. Please note that while 2018 results were distributed earlier this year, associated payment adjustments are yet to be made.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841