DOH Presents MLTC Value-Based Payment Plans to Clinical Advisory Group

The Department of Health (DOH) hosted a webinar last week to present its plans for quality measurement under managed long term care (MLTC) value-based payment (VBP) to its Clinical Advisory Group. The Department announced that the 2018 quality measure set for MLTC VBP will be modified to remove the existing falls measure. The current measure – percent of members who did not have falls resulting in medical intervention in the last 90 days – is under review, and a new falls measure (covering falls with injury) is under consideration. The presentation also included a timeline for collection of attribution data and release of performance data. The slides from the webinar are available here, and the MLTC VBP quality measures are available here.

The webinar also included a review of the Department's plans for MLTC VBP Level 2, which will require incentives for performance on the potentially avoidable hospitalization (PAH) measure and at least one other approved measure. The Department has not determined how nursing homes will be treated under MLTC VBP Level 2, given the impending three-month limitation on the MLTC nursing home benefit for permanently-placed members. It posed a series of questions to webinar viewers:

• Can performance-based payments to nursing homes be prorated to cover a portion of the year?
• Is there sufficient opportunity to improve outcomes within the limited benefit period? On the PAH measure or other measures?
• Are there other possible approaches?

The Department announced that penalties imposed on MLTC plans for failure to meet VBP contracting targets will be increasing to 2 percent of the marginal difference between the target and the actual level achieved.

LeadingAge NY members are encouraged to submit their views on the questions above and feedback on MLTC VBP strategies to DOH here. Members are also encouraged to submit their feedback to LeadingAge NY here. More information on the Department's plans for MLTC VBP Level 2 is available here.

The Clinical Advisory Group will be convened again in August to review the final measure set.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124