DOH Releases "Off-Menu" Value-Based Payment Checklist

The Department of Health (DOH) has released a new value-based payment (VBP) checklist for Medicaid managed care contracts with providers that deviate from the models set forth in the State's VBP Roadmap. The new guidance document, entitled "Off-Menu Value-Based Payment Checklist," delineates the prerequisites for an "off-menu" arrangement and incorporates a series of questions concerning the nature of the arrangement. Managed care plans are directed to submit the checklist to the Department for review and approval, along with the proposed off-menu provider contract.

The checklist appears to have been designed for mainstream managed care plans and does not appear to apply to partially-capitated managed long term care (MLTC) plans. Its description of the "Level 1" risk model requires a specified level of shared savings and does not align with the Level 1 pay-for-performance VBP approach taken by the Department for partially-capitated MLTC plans. However, as indicated in other recent guidance, the Department appears to be treating integrated Medicare-Medicaid managed care plans, such as Medicaid Advantage Plans (MAP), Fully-Integrated Duals Advantage (FIDA) plans, and Programs of All-Inclusive Care for the Elderly (PACE), like mainstream managed care plans for VBP purposes. Thus, the checklist may apply to off-menu VBP arrangements proposed by those plans.

The checklist is available here. Additional guidance documents on provider contracting are available here.

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