VBP Contract Amendments Required by the End of the Year

Nursing home and home care providers who have not yet done so should familiarize themselves with the requirements and resources for including a Value Based Payment (VBP) amendment to their contracts with Managed Long Term Care (MLTC) plans. The state is requiring that all MLTC plans convert contracts with nursing homes, Certified Home Health Agencies (CHHAs), and Licensed Home Care Services Agencies (LHCSAs) into "MLTC Level 1 VBP arrangement contracts" that include an avoidable hospitalization measure by Dec. 31, 2017. Level 1 VBP contracts under MLTC entail performance bonuses based on meeting targets for a specific quality measure or set of measures.

This means that plans will be amending contracts with their network providers to reflect these requirements. Members who have been following developments on the Value-Based Payment page of the LeadingAge NY website know that the end-of-the-year deadline was established several months ago, but that more complete information and optional model contract templates have been provided fairly recently. We continue to seek clarification on several issues.

Providers should note that while plans may offer contract amendments that include more complex VBP provisions, given the short timelines, most may focus on Level 1 using the avoidable hospitalization measure. While MLTC Level 1 contracts are pay-for-performance arrangements with no downside risk, there is also very limited funding associated with the program, so it may be unlikely that these amendments will result in significant or any additional payments at the outset.

For contracts with nursing homes, the required hospitalization measure is the same as the one included in the Nursing Home Quality Initiative (i.e., number of potentially avoidable hospitalizations per 10,000 long stay days). The Department of Health (DOH) has calculated and posted facility-specific rates for the 2016 measurement year, which are available here and can be accessed on the HealthData NY website. Additional measures that have been approved for optional inclusion in VBP arrangements with nursing homes are listed in the MLTC Clinical Advisory Group Value Based Payment Recommendations report. The Skilled Nursing Facility (SNF) contract amendment template is posted on the DOH VBP Resource Library page in the VBP MLTC section.

VBP contracts between MLTC plans and CHHAs or LHCSAs must include the MLTC Incentive Potentially Avoidable Hospitalization (PAH) measure as a pay-for-performance measure. Other measures from the Category 1 measures list (available here) may be included as deemed appropriate by the contracting parties. For LHCSAs and CHHAs, all Category 1 quality measures, including PAH, will be calculated by DOH for plan-provider combinations for attributed member groups submitted to DOH. The home care contract amendment template is also posted on the DOH VBP Resource Library page in the VBP MLTC section.

Please note that DOH stresses that the contract amendment templates are to be used solely as an optional tool to assist plans who are getting started with VBP contracting. Use of the templates in any form is not mandatory, and if the templates are used, they may be modified.

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