DOH Releases Final Update to Medicaid Value-Based Payment Roadmap

The Department of Health (DOH) released a final version of its updated framework for value-based payment (VBP) under Medicaid last week. Entitled "A Path toward Value Based Payment, New York State Roadmap for Medicaid Payment Reform," the Roadmap is described as "the foundational document governing NYS DOH expectations for Managed Care Organizations (MCOs) and providers to move towards VBP reform." Given the expectation that the majority of the funds to be distributed under the State's proposed $13.5 billion Medicaid waiver will be distributed through VBP arrangements, the Roadmap will drive a substantial investment in the State's health system.

It appears that the final Roadmap maintains the optional status of VBP for partially capitated Managed Long Term Care (MLTC) plans. As indicated in the earlier draft, the final Roadmap notes that the Department will not be calculating the VBP measures for long term care, except for the potentially avoidable hospitalization measure. Since partially capitated MLTC plans are the single largest payer for community-based long term care in New York State, and since advanced VBP is expected to drive investment under the waiver, the near abandonment of partially capitated plans in the State's VBP framework is troubling.

The updated Roadmap also continues to require VBP arrangements for fully capitated MLTC plans (i.e., Medicaid Advantage Plus (MAP) and Programs of All-Inclusive Care for the Elderly (PACE programs)). MAP and PACE programs are subject to the same general requirements as mainstream managed care plans.

LeadingAge NY raised its concerns regarding the Roadmap in comments on a draft version released several months ago. The documents released last week include a summary of public comment. LeadingAge NY will be analyzing the documents released last week and following up with DOH. The final updated Roadmap is available here (click on the VBP Roadmap button), and a summary of the draft Roadmap is here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383