DOH Refines Approach to MLTC Value-Based Payment

The Department of Health (DOH) announced last week that it will leverage the existing Managed Long Term Care (MLTC) Quality Incentive Pool to support its effort to shift Medicaid reimbursement to value-based payment arrangements. Under the state's Value-Based Payment Roadmap, at least 80 to 90 percent of payments by managed care plans to providers must be made through value-based arrangements by April 1, 2020. The Roadmap provides that, for MLTC plans and providers, quality-related pay-for-performance arrangements qualify as value-based for purposes of meeting that target.

The MLTC Quality Incentive Pool is funded through a 2 percent withhold from MLTC plan premiums, which is partially redistributed to plans based on their performance on specified quality, efficiency, satisfaction, and compliance measures. Under the Department's plan, the state's Quality Incentive Pool payments to MLTC plans will be counted toward its value-based payment target. The Department will not be imposing penalties on MLTC plans that fail to reach a targeted level of value-based arrangements with providers. It is, however, encouraging MLTC plans and providers to enter into pay-for-performance arrangements based on the selected quality measures. In addition, the Department is soliciting proposals from providers and plans that are interested in implementing pilot programs involving shared savings or two-sided risk arrangements.

This approach was announced on the heels of the adoption of the MLTC Clinical Advisory Group (CAG) report by the state's Value-Based Payment Work Group. The CAG report sets forth the quality measures that will be used in value-based payment arrangements. They incorporate most of the community-based quality measures used in the MLTC Quality Incentive Pool program, including a potentially avoidable hospitalizations measure for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection.

The Department's MLTC value-based payment strategy is currently focused on partially-capitated MLTC plans because the overwhelming majority of MLTC beneficiaries are enrolled in partially-capitated plans. However, the Department will be convening the MLTC Clinical Advisory Group and other stakeholders to develop value-based payment options for the integrated Medicare-Medicaid plans – Fully-Integrated Duals Advantage (FIDA), Programs of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP).

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