VBP QIP July 2017 LOI

Submission Guidelines

  • LOI is also available in Portable Document Format (PDF)
The second Value Based Payment Quality Improvement Program (VBP QIP) Facility Letter of Intent (LOI) submission is due by June 30, 20171

By June 30, 2017, every Facility participating in the VBP QIP must:

  1. Have at least one Level 1 VBP contract in place with a Medicaid Managed Care Organization (MCO) (the MCO can be different from its VBP QIP paired MCO)
    1. The Facility must provide its VBP QIP paired MCO with a letter signed by a representative from the contracting MCO, attesting that the partners have at least a Level 1 VBP contract in place that fulfills the requirements of the New York State (NYS) VBP Roadmap
AND
  1. Obtain signed LOIs with as many MCOs such that the Facility will have 80% of its total Medicaid MCO contracted payments tied to Level 1 (or higher) VBP arrangements consistent with the requirements outlined in the NYS VBP Roadmap
    1. The Facility must submit all LOIs to its VBP QIP paired MCO for review and to the NYS Department of Health (DOH) for record keeping.

All LOI submissions should be sent by no later than June 30, 2017 to the NYS DOH at vbp_qip@health.ny.gov with "VBP QIP – LOI" in the subject line.

Letter of Intent

The VBP QIP Facility2 __________________________and MCO partner3 _______________________ hereby agree on the intent to sign VBP arrangement(s), as defined by the NYS VBP Roadmap, by no later than April 1, 2018.

The VBP QIP Facility and MCO submit this LOI based on the following conditions:

  • VBP Contract / Contract Addendum Date: By April 1, 2018, a VBP contract(s)/ contract addendum(a) must be submitted to the NYS DOH. The Facility will also send its VBP QIP paired MCO a VBP QIP Contract Attestation(s) signed by a senior leader from both the VBP QIP Facility and the Facility´s partnering Medicaid MCO stating the existence of a qualifying VBP contract(s).
  • Timeline: The LOIs submitted by June 30, 2017 must have contract effective date(s) of no later than April 1, 2018.
  • Scope: The VBP contract must be consistent with the NYS VBP Roadmap as well as the VBP QIP Facility Plan Guidance document. Additionally, the contract must be at least a Level 1 risk level.

VBP Contract Information

  1. MCO Name:                    _________________________________________________
    • Contact Person:       _________________________________________________
    • Phone #:                    _________________________________________________
    • Email Address:         _________________________________________________
  2. VBP QIP Facility Name:  _________________________________________________
    • Contact Person:       _________________________________________________
    • Phone #:                    _________________________________________________
    • Email Address:         _________________________________________________
  3. Please check all applicable information the Facility intends to apply to its contract(s) with this Medicaid MCO:
Type of arrangement/contract Level 1 Level 2 Level 3 Anticipated contract effective date Contract is between4 (circle one) Lead VBP contracting entity name
Total Care for General Population ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Integrated primary care ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Bundle (for all that apply) ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Chronic Bundle ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Maternity Bundle ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Other Bundle (Please Describe): ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Total Care for Subpopulation (Please list subpopulations included) ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Off‐menu (please describe if applicable): ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Off‐menu (please describe if applicable): ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
Off‐menu (please describe if applicable): ☐ ☐ ☐   IPA
ACO
Other Lead
VBP QIP Facility		  
  1. If the contract is between a MCO and a VBP Contractor, please provide the following information for each VBP contracting entity:
    • VBP Contracting Entity Name: ________________________________________________
    • VBP Arrangement _________________________________________________________
    • Primary Contact Name and Title: ______________________________________________
    • Address: ________________________________________________________________
    • City: _______________________________ State: ____________ Zip: ________________
    • Contact Phone: ______________________ Contact Email: _________________________


    • VBP Contracting Entity Name: ________________________________________________
    • VBP Arrangement _________________________________________________________
    • Primary Contact Name and Title: ______________________________________________
    • Address: ________________________________________________________________
    • City: _______________________________ State: ____________ Zip: ________________
    • Contact Phone: ______________________ Contact Email: _________________________


    • VBP Contracting Entity Name: ________________________________________________
    • VBP Arrangement _________________________________________________________
    • Primary Contact Name and Title: ______________________________________________
    • Address: ________________________________________________________________
    • City: _______________________________ State: ____________ Zip: ________________
    • Contact Phone: ______________________ Contact Email: _________________________


    • VBP QIP Facility Name: __________________________________________
    • Authorizing Signature: ___________________________________________      Date _______________
    • Authorizing Signature Name: ______________________________________
    • Authorizing Signature Title: ________________________________________


    • Contracting MCO Name: ________________________________________
    • Authorizing Signature: ___________________________________________      Date _______________
    • Authorizing Signature Name: ______________________________________
    • Authorizing Signature Title: ________________________________________

___________________________

1. The first LOI submission, due on April 1, 2017, required every Facility participating in the VBP QIP to submit at least one (1) signed LOI to its VBP QIP paired MCO stating that the Facility and a Medicaid MCO (of its choice) were expecting to enter into a Level 1 (or higher) VBP contract by June 30, 2017.  1
2. A VBP QIP Facility may enter a VBP contract as a primary VBP Contractor or as a member/partner of a larger VBP contracting entity.  2
3. This should be the MCO partner executing a VBP contract with the VBP QIP Facility, which may or may not be the MCO paired with the Facility for VBP QIP.  3
4. As per the LOI, a contract is between an MCO and either: (1) an IPA/ACO which the VBP QIP Facility has a VBP Agreement with; (2) another "Lead Hospital" which the VBP QIP Facility has a VBP Agreement with; (3) the VBP QIP Facility. For #1 and 2, please specify the IPA/ACO/Lead contractor name in the last column.  4