On-Menu Checklist

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Index

    Integrated Primary Care (IPC) Checklist

    Maternity Care Checklist

    Total Care for General Population (TCGP) Checklist

    HARP Checklist

    HIV/AIDS Checklist

    Managed Long Term Care (MLTC) Checklist


Integrated Primary Care (IPC) Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? Integrated Primary Care (IPC)
Definition: All Medicaid covered services included in preventive and routine sick care are included, as well as all services included in the 14 Chronic Care Episodes.
 
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? Roadmap (page 36):
1. Preventive Care
2. Sick Care
3. Chronic Care, specifically:
  1. Hypertension
  2. Coronary Artery Disease (CAD)
  3. Arrhythmia, Heart Block and Conductive Disorders
  4. Congestive Heart Failure (CHF)
  5. Asthma
  6. Chronic Obstructive Pulmonary Disease (COPD)
  7. Bipolar Disorder
  8. Depression & Anxiety
  9. Trauma & Stressor
  10. Substance Use Disorder (SUD)
  11. Diabetes
  12. Gastro–esophageal reflux disease
  13. Osteoarthritis
  14. Lower Back Pain
If the contract is missing any of the elements above, this is an OFF–MENU arrangement, it will be reviewed by the Off–Menu Committee.
 
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? Roadmap (p. 34)
The State mandates the reporting of all reportable Category 1 Measures in on–menu contracts. Inclusion of Category 2 measures is optional.
Additional measures, beyond those outlined in Categories 1 and 2, may be added to the contract.

If at least one (1) reportable Category 1 measure is missing, this is an OFF-MENU arrangement It will be reviewed by the Off–Menu Committee (inclusion of Category 2 measures is optional).
 
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? Roadmap (p. 86)
  • Level 1: FFS with Retrospective Reconciliation – Upside Only Risk
  • Level 2: FFS with Retrospective Reconciliation – Up– and Downside Risk
  • Level 3: Prospective Payments (PMPM or Bundled Payments; fully capitated or prospectively paid bundles). These arrangements may also include additional risk mitigation strategies like risk corridors, stop loss, withholds, etc.
The VBP Roadmap requires a minimum amount of risk be adopted per level. In order to be labeled a certain risk level arrangement, it must match definitions listed in Appendix X of the Roadmap: Definitions of Level 1, 2 and 3 VBP Arrangements.
 
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? Roadmap (page 86)
  1. While the State does not mandate a specific shared savings/losses distribution methodology, the following minimums must be met in order align with VBP Level definitions:
    • Level 1: Minimum of 40% of shared savings must be allocated to the provider
    • Level 2: Minimum of 20% of potential losses must be allocated to the provider, and a minimum cap of 3% of the target budget can be applied in Year 1 and 5% in Year 2 Below these levels, the VBP arrangement is counted as a Level 1 arrangement.
    • Level 3: N/A
 
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? The contract must list quality measures agreed upon for calculating shared savings and losses. At least one (1) Category 1 P4P quality measure must be selected.  
(6) Attribution Does the contract describe the attributed population? Roadmap (page 23–24):
While the State does not mandate a specific methodology to be used to attribute members to an arrangement, the contract should specify the attribution methodology.
 
(7) Target Budget Does the contract describe the Target Budget in this arrangement? Roadmap (page 24–28):
The State does not mandate a specific methodology to be used to calculate Target Budget (TB) for an arrangement. However, the contracts should specify that a target budget will be used.
 
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? Roadmap (page 41):
VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention.
 
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? Roadmap (page 42):
It is a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 Community Based Organization.

Tier 1 – Non–profit, non–Medicaid billing, community based social and human service organizations (e.g. housing, social services, religious organizations, food banks).

Exception: The State recognizes that CBOs may not exist within a reasonable distance to providers in some regions of New York. In such situations, providers/provider networks can apply to the State for a rural exemption.
 
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Maternity Care Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? All Medicaid covered services included in the episodes for all pregnant women (and their newborns) eligible for mainstream managed care (excluding duals).  
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? Roadmap (page 36):
  1. Pregnancy
  2. Vaginal Delivery
  3. C–Section
  4. Newborn
If the contract is missing any of the elements above, this is an OFF–MENU contract, it will be reviewed by the Off–Menu Committee.
 
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? Roadmap (p. 34)
The State mandates the reporting of all reportable Category 1 Measures in on–menu contracts. Inclusion of Category 2 measures is optional.
Additional measures, beyond those outlined in Categories 1 and 2, may be added to the contract.

If at least one (1) reportable Category 1 measure is missing, this is an OFF–MENU arrangement It will be reviewed by the Off–Menu Committee (inclusion of Category 2 measures is optional).
 
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? Roadmap (p. 86)
  • Level 1: FFS with Retrospective Reconciliation – Upside Only Risk
  • Level 2: FFS with Retrospective Reconciliation – Up– and Downside Risk
  • Level 3: Prospective Payments (PMPM or Bundled Payments; fully capitated or prospectively paid bundles). These arrangements may also include additional risk mitigation strategies like risk corridors, stop loss, withholds, etc.
The VBP Roadmap requires a minimum amount of risk be adopted per level. In order to be labeled a certain risk level arrangement, it must match definitions listed in Appendix X of the Roadmap: Definitions of Level 1, 2 and 3 VBP Arrangements.
 
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? Roadmap (page 86)
  1. While the State does not mandate a specific shared savings/losses distribution methodology, the following minimums must be met in order align with VBP Level definitions:
    • Level 1: Minimum of 40% of shared savings must be allocated to the provider
    • Level 2: Minimum of 20% of potential losses must be allocated to the provider, and a minimum cap of 3% of the target budget can be applied in Year 1 and 5% in Year 2 Below these levels, the VBP arrangement is counted as a Level 1 arrangement.
    • Level 3: N/A
 
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? The contract must list quality measures agreed upon for calculating shared savings and losses. At least one (1) Category 1 P4P quality measure must be selected.  
(6) Attribution Does the contract describe the attributed population? Roadmap (page 23–24):
While the State does not mandate a specific methodology to be used to attribute members to an arrangement, the contract should specify the attribution methodology.
 
(7) Target Budget Does the contract describe the Target Budget in this arrangement? Roadmap (page 24–28):
The State does not mandate a specific methodology to be used to calculate Target Budget (TB) for an arrangement. However, the contracts should specify that a target budget will be used.
 
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? Roadmap (page 41):
VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention.
 
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? Roadmap (page 42):
It is a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 Community Based Organization.

Tier 1 – Non–profit, non–Medicaid billing, community based social and human service organizations (e.g. housing, social services, religious organizations, food banks).

Exception: The State recognizes that CBOs may not exist within a reasonable distance to providers in some regions of New York. In such situations, providers/provider networks can apply to the State for a rural exemption.
 
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Total Care for General Population (TCGP) Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? All Medicaid covered services for all members eligible for mainstream managed care and not eligible for one of the subpopulations (excluding duals).  
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? Roadmap (page 35):
All Medicaid covered services for all members eligible for mainstream managed care and not eligible for one of the subpopulations (excluding duals).

If the contract carves out any services, then this is an OFF–MENU arrangement, it will be reviewed by the Off–Menu Committee. The inclusion of dental and/or vision services are not required as part of this ON–MENU arrangement.
 
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? Roadmap (p. 34)
The State mandates the reporting of all reportable Category 1 Measures in on–menu contracts. Inclusion of Category 2 measures is optional.
Additional measures, beyond those outlined in Categories 1 and 2, may be added to the contract.

If at least one (1) reportable Category 1 measure is missing, this is an OFF–MENU arrangement It will be reviewed by the Off–Menu Committee (inclusion of Category 2 measures is optional).
 
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? Roadmap (p. 86)
  • Level 1: FFS with Retrospective Reconciliation – Upside Only Risk
  • Level 2: FFS with Retrospective Reconciliation – Up– and Downside Risk
  • Level 3: Prospective Payments (PMPM or Bundled Payments; fully capitated or prospectively paid bundles). These arrangements may also include additional risk mitigation strategies like risk corridors, stop loss, withholds, etc.
The VBP Roadmap requires a minimum amount of risk be adopted per level. In order to be labeled a certain risk level arrangement, it must match definitions listed in Appendix X of the Roadmap: Definitions of Level 1, 2 and 3 VBP Arrangements.
 
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? Roadmap (page 86)
  1. While the State does not mandate a specific shared savings/losses distribution methodology, the following minimums must be met in order align with VBP Level definitions:
    • Level 1: Minimum of 40% of shared savings must be allocated to the provider
    • Level 2: Minimum of 20% of potential losses must be allocated to the provider, and a minimum cap of 3% of the target budget can be applied in Year 1 and 5% in Year 2 Below these levels, the VBP arrangement is counted as a Level 1 arrangement.
    • Level 3: N/A
 
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? The contract must list quality measures agreed upon for calculating shared savings and losses. At least one (1) Category 1 P4P quality measure must be selected.  
(6) Attribution Does the contract describe the attributed population? Roadmap (page 23–24):
While the State does not mandate a specific methodology to be used to attribute members to an arrangement, the contract should specify the attribution methodology.
 
(7) Target Budget Does the contract describe the Target Budget in this arrangement? Roadmap (page 24–28):
The State does not mandate a specific methodology to be used to calculate Target Budget (TB) for an arrangement. However, the contracts should specify that a target budget will be used.
 
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? Roadmap (page 41):
VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention.
 
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? Roadmap (page 42):
It is a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 Community Based Organization.

Tier 1 – Non–profit, non–Medicaid billing, community based social and human service organizations (e.g. housing, social services, religious organizations, food banks).

Exception: The State recognizes that CBOs may not exist within a reasonable distance to providers in some regions of New York. In such situations, providers/provider networks can apply to the State for a rural exemption.
 
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HARP Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? All Medicaid covered services for all members eligible for HARP (excluding duals).  
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? Roadmap (page 35):
All Medicaid covered services for all members eligible for HARP (excluding duals).

If the contract carves out any services, then this is an OFF–MENU arrangement, it will be reviewed by the Off–Menu Committee.
 
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? Roadmap (p. 34)
The State mandates the reporting of all reportable Category 1 Measures in on–menu contracts. Inclusion of Category 2 measures is optional.
Additional measures, beyond those outlined in Categories 1 and 2, may be added to the contract.

If at least one (1) reportable Category 1 measure is missing, this is an OFF–MENU arrangement It will be reviewed by the Off–Menu Committee (inclusion of Category 2 measures is optional).
 
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? Roadmap (p. 86)
  • Level 1: FFS with Retrospective Reconciliation – Upside Only Risk
  • Level 2: FFS with Retrospective Reconciliation – Up– and Downside Risk
  • Level 3: Prospective Payments (PMPM or Bundled Payments; fully capitated or prospectively paid bundles). These arrangements may also include additional risk mitigation strategies like risk corridors, stop loss, withholds, etc.
The VBP Roadmap requires a minimum amount of risk be adopted per level. In order to be labeled a certain risk level arrangement, it must match definitions listed in Appendix X of the Roadmap: Definitions of Level 1, 2 and 3 VBP Arrangements.
 
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? Roadmap (page 86)
  1. While the State does not mandate a specific shared savings/losses distribution methodology, the following minimums must be met in order align with VBP Level definitions:
    • Level 1: Minimum of 40% of shared savings must be allocated to the provider
    • Level 2: Minimum of 20% of potential losses must be allocated to the provider, and a minimum cap of 3% of the target budget can be applied in Year 1 and 5% in Year 2 Below these levels, the VBP arrangement is counted as a Level 1 arrangement.
    • Level 3: N/A
 
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? The contract must list quality measures agreed upon for calculating shared savings and losses. At least one (1) Category 1 P4P quality measure must be selected.  
(6) Attribution Does the contract describe the attributed population? Roadmap (page 23–24):
While the State does not mandate a specific methodology to be used to attribute members to an arrangement, the contract should specify the attribution methodology.
 
(7) Target Budget Does the contract describe the Target Budget in this arrangement? Roadmap (page 24–28):
The State does not mandate a specific methodology to be used to calculate Target Budget (TB) for an arrangement. However, the contracts should specify that a target budget will be used.
 
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? Roadmap (page 41):
VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention.
 
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? Roadmap (page 42):
It is a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 Community Based Organization.

Tier 1 – Non–profit, non–Medicaid billing, community based social and human service organizations (e.g. housing, social services, religious organizations, food banks).

Exception: The State recognizes that CBOs may not exist within a reasonable distance to providers in some regions of New York. In such situations, providers/provider networks can apply to the State for a rural exemption.
 
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HIV/AIDS Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? All Medicaid covered services for all members eligible for HIV/AIDS special needs population (excluding duals).  
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? Roadmap (page 35):
All Medicaid covered services for all members eligible for HIV/AIDS special needs population (excluding duals).

If the contract carves out any services, then this is an OFF–MENU arrangement, it will be reviewed by the Off–Menu Committee.
 
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? Roadmap (p. 34)
The State mandates the reporting of all reportable Category 1 Measures in on–menu contracts. Inclusion of Category 2 measures is optional.
Additional measures, beyond those outlined in Categories 1 and 2, may be added to the contract.

If at least one (1) reportable Category 1 measure is missing, this is an OFF–MENU arrangement It will be reviewed by the Off–Menu Committee (inclusion of Category 2 measures is optional).
 
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? Roadmap (p. 86)
  • Level 1: FFS with Retrospective Reconciliation – Upside Only Risk
  • Level 2: FFS with Retrospective Reconciliation – Up– and Downside Risk
  • Level 3: Prospective Payments (PMPM or Bundled Payments; fully capitated or prospectively paid bundles). These arrangements may also include additional risk mitigation strategies like risk corridors, stop loss, withholds, etc.
The VBP Roadmap requires a minimum amount of risk be adopted per level. In order to be labeled a certain risk level arrangement, it must match definitions listed in Appendix X of the Roadmap: Definitions of Level 1, 2 and 3 VBP Arrangements.
 
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? Roadmap (page 86)
  1. While the State does not mandate a specific shared savings/losses distribution methodology, the following minimums must be met in order align with VBP Level definitions:
    • Level 1: Minimum of 40% of shared savings must be allocated to the provider
    • Level 2: Minimum of 20% of potential losses must be allocated to the provider, and a minimum cap of 3% of the target budget can be applied in Year 1 and 5% in Year 2 Below these levels, the VBP arrangement is counted as a Level 1 arrangement.
    • Level 3: N/A
 
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? The contract must list quality measures agreed upon for calculating shared savings and losses. At least one (1) Category 1 P4P quality measure must be selected.  
(6) Attribution Does the contract describe the attributed population? Roadmap (page 23–24):
While the State does not mandate a specific methodology to be used to attribute members to an arrangement, the contract should specify the attribution methodology.
 
(7) Target Budget Does the contract describe the Target Budget in this arrangement? Roadmap (page 24–28):
The State does not mandate a specific methodology to be used to calculate Target Budget (TB) for an arrangement. However, the contracts should specify that a target budget will be used.
 
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? Roadmap (page 41):
VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention.
 
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? Roadmap (page 42):
It is a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 Community Based Organization.

Tier 1 – Non–profit, non–Medicaid billing, community based social and human service organizations (e.g. housing, social services, religious organizations, food banks).

Exception: The State recognizes that CBOs may not exist within a reasonable distance to providers in some regions of New York. In such situations, providers/provider networks can apply to the State for a rural exemption.
 
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Managed Long Term Care (MLTC) Checklist
1 Plan Name  
2 IPA/ ACO/ Provider Name  
# Verifying Questions Review (at least one box must be checked) Description Specify Contract Page Number
(1) Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition? In Development.  
(2) Definition and Scope of Services Does the scope of services state that it will match the VBP Roadmap definition? In Development.  
OR does the contract list all of the episodes (see the list below)?
(3) Quality Measures/Reporting Does the contract commit to reporting on all Category 1 quality measures approved by the State? In Development.  
OR does the contract list any Category 1 quality measure that the MCO will report on?
(4) Risk Level Does the contract describe the level of risk chosen by the contracting parties? In Development.  
(5A) Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? In Development.  
(5B) Shared Savings/Losses Does the contract align with quality measure requirements for shared savings/losses? In Development.  
(6) Attribution Does the contract describe the attributed population? In Development.  
(7) Target Budget Does the contract describe the Target Budget in this arrangement? In Development.  
(8) Social Determinants of Health Intervention If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health? In Development.  
(9) Contracting with Community Based Organizations (starting January 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization? In Development.  
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