Equity Programs (EP) Monthly Update Webinar
- Webinar also available in Portable Document Format (PDF)
September 6, 2017
Today´s Agenda
- EPP Background and Evaluation Methodology
- EPP Results
- EP Funding
- EP Reporting
- Next Steps and Open Forum
EPP Background and Evaluation Methodology
EPP Background
- The primary purpose of the Equity Programs (EPs) is to mitigate inequities in PPS funding that arose during the DSRIP valuation process.
- Each PPS is paired with at least one MCO.
- PPS select 6 DSRIP measures from a set of 25. MCOs will review IA validated PPS performance on these 6 measures to determine the EPP award. The 6 selected measures can be the same or different across MCO partners.
- Only SBH and Millennium selected different sets of measures for their MCO partners.
- Each measure is weighted equally for payment purposes. Earning achievement on 5/6 measures means the PPS earns 5/6 of the total payment for the period.
EPP Performance and Evaluation Methodology
- P4R measures are achieved if the PPS fulfills their reporting requirements as part of the DSRIP program.
- P4P measures are achieved if the PPS hits the 10% gap–to–goal Annual Improvement Target.
- Partial achievement has been approved and will apply to MY2 results for EPP
- 0%–2.4% gap–to–goal achieved = 0% of funds associated with measure
- 2.5%–4.9% gap–to–goal achieved = 25% of funds
- 5.0%–7.4% gap–to–goal achieved = 50% of funds
- 7.5%–9.9% gap–to–goal achieved = 75% of funds
- Partial achievement has been approved and will apply to MY2 results for EPP
- At least one selected measure must turn P4P in DY2 or DY3.
EPP Results
EPP Measure Achievement in DY2
| PPS Name | Measures Earned | Measures Selected | P4P Measures Earned | P4P Measured Selected |
|---|---|---|---|---|
| Advocate Community Partners, Inc. | 6 | 6 | 0 | 0 |
| Bronx–Lebanon Hospital Center | 4 | 6 | 0 | 2 |
| Central New York Care Collaborative | 6 | 6 | 0 | 0 |
| Maimonides Medical Center | 6 | 6 | 0 | 0 |
| Millennium Collaborative Care | 11.75 | 15 | 1.75 | 5 |
| Montefiore Medical Center | 4.5 | 6 | 0.5 | 2 |
| Mount Sinai PPS, LLC | 6 | 6 | 1 | 1 |
| Nassau Queens Performing Provider System | 6 | 6 | 0 | 0 |
| New York–Presbyterian/Queens | 6 | 6 | 0 | 0 |
| NYU Lutheran Medical Center | 5 | 6 | 5 | 6 |
| Refuah Community Health Collaborative | 5 | 6 | 1 | 2 |
| SBH Health System | 6.25 | 7 | 1.25 | 2 |
| Sisters of Charity Hospital of Buffalo, New York | 5 | 6 | 1 | 2 |
| State University of New York at Stony Brook University Hospital | 6 | 6 | 0 | 0 |
| The New York and Presbyterian Hospital | 6 | 6 | 0 | 0 |
EPP Performance Payment Summary
| Total EPP dollars available in DY2: | $128,400,000 |
| Total EPP dollars earned in DY2: | $120,788,720 |
| Unearned DY2 EPP dollars to flow into AHPP in DY3: | $7,611,380 |
| Percentage of total available DY2 EPP dollars earned: | 94% |
EP Funding
EPP Payments
- After receipt of EPP performance results from the IA, EPP DY2 payments will be made to PPS retroactively to April 2017.
- Payments will continue through March 2018.
- A lag in EPP payments between the MCOs and PPS will occur each year. EPP payments will not be made from MCOs to PPS Equity Program while the IA conducts performance validation.
EP Rate Adjustments
- DOH continues to work with CMS and the Division of Budget (DOB) on a set of January 2017 EIP rate adjustments, which will reconcile any shortfalls/averages for DY2.
- DOH will notify affected MCOs and PPS once the rate adjustments are approved.
- Rates will be updated and submitted annually at the beginning of the DY (April). If April rates get delayed, MCOs will continue to get the per member per month (PMPM) amounts from the previous year until the updated rates get approved.
- MCOs will continue to receive DY2 rates until the April 2017 rate package is approved.
- Once rates are approved, there is a rate adjustment in January of the following year for any rate issue that arise.
- There may be a January 2018 rate adjustment for rate issues that arise from April 2017 rates.
EP Reporting
DY3 Reporting
- PPS and MCOs should send reports (and supporting documentation) to the entity at the appropriate email address noted below.
- EP Reporting Tables can be found on the EP website at
www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_initiatives/supplemental_programs.htm
- EP Reporting Tables can be found on the EP website at
| Report | Completed by | Submitted to | Frequency | Location |
|---|---|---|---|---|
| EP Contracts | PPS & MCO | IA & DOH | Annually | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EP Frequency Table | MCO | IA & DOH | Annually | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EIP Activity Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EIP Payment Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| MCO EPP Payment Table | MCO | IA & DOH | Based on EP Contracts | dsrip_ia@pcgus.com dsrip_ssp@health.ny.gov |
| PPS EIP Activity Table | PPS | MCOs | Based on EP Contracts | MCO contact emails |
| Supporting Documentation for EIP Activity participation | PPS | MCOs | Based on EP Contracts | MCO contact emails |
| Supporting Documentation for EIP Activity participation | MCO (reviewed by MCO after being sent by PPS) | IA | Based on EP Contracts | dsrip_ia@pcgus.com |
Next Steps and Open Forum
- EP webinars are now scheduled quarterly. DOH will follow up with a future webinar date.
- For any further questions, please contact the Supplemental Programs inbox: dsrip_ssp@health.ny.gov.
- The remainder of this webinar is reserved for an open forum.
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