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DOH Unveils 2022 MLTC Quality Incentive Methodology

The Department of Health (DOH) has circulated the methodology that it will use to calculate 2022 Managed Long Term Care (MLTC) Quality Incentive payments. Although the two-year lag between measurement and payment means that actual payments will not be made until State Fiscal Year (SFY) 2024-25, quality measures will be calculated based on Uniform Assessment System (UAS) community health assessment data spanning January through December 2022, compliance measures from 2021, and satisfaction survey results collected in 2021. 

The methodology will rely on three domains: seven quality measures worth a total of 50 points, six satisfaction measures worth a total of 30 points, and four compliance measures worth a total of 10 points.

The quality measures, most of which are calculated from the UAS, include:

  • Percentage of members who received an influenza vaccination in the last year
  • Percentage of members age 65 or older who received a pneumococcal vaccination in the last five years or after age 65
  • Percentage of members who received a dental exam in the last year
  • Percentage of members who received an eye exam in the last year
  • Percentage of members who received a hearing exam in the last two years
  • Percentage of female members ages 50 to 74 who received a mammogram or breast exam in the last two years
  • Percentage of members who responded that a health plan representative talked to them about appointing someone to make decisions about their health if they are unable to do so (from the satisfaction survey)

Each measure that is greater than or equal to the 90th percentile in the state is awarded the maximum 7.1 points. For those in the 75th to 90th percentile, 4.8 points are awarded, with 2.4 points awarded to those between the 50th and 75th percentile.

The satisfaction survey measures the age/education/self-reported health status risk-adjusted percentage of members who:

  • responded that they are usually or always involved in making decisions about their plan of care
  • reported that within the last six months, the home health aide/personal care aide/personal assistant services were usually or always on time
  • rated the helpfulness of the plan in assisting them and their family to manage their illnesses as good or excellent
  • rated the quality of care manager/case manager services within the last six months as good or excellent
  • rated the quality of home health aide/personal care aide/personal assistant services within the last six months as good or excellent 

Results significantly higher than the state average score five points, while results in line with the average score 2.5 points. The final domain provides up to 10 points, which are awarded based on compliance with network data, cost report, and encounter data submission for 2021, as well as cost report and encounter data reporting congruity.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841