Guidance for Submitting VBP Contracts for Partially Capitated Plans

December 6, 2017

  • Guidance is also available in Portable Document Format (PDF)

In accordance with MLTC VBP requirements, Partially Capitated MLTC plans are required to submit contract amendments and/or new contracts that fulfill VBP requirements to the NYS Department of Health by December 31, 2017, for contracts to be in place by January 1, 2018. Contracts and amendments with VBP arrangements should be sent following the usual contract submission process, via the email address.

Each submission must also include a completed DOH 4255 form. Please note that the DOH 4255 does not yet give MLTC VBP levels as a specific choice. Plans can choose VBP Level 0 in the absence of a choice for MLTC VBP Level 1.

For MLTC VBP Level 1, the submission will be reviewed to ensure it includes both the Potentially Avoidable Hospitalization (PAH) measure, and an Upside Performance Bonus. The PAH measure is the minimum requirement, though plans may choose to include additional measures. Refer to the VBP Road Map for guidance in selecting additional measures.

There are two types of VBP contract submissions:

1. Contract Amendments or Contract Template Amendments

When submitting a contract amendment, Plans must check the Material Amendment box and include the Original Contract Number, Original Approval Date, and Original Effective Date in Section A, Question 1 of the 4255 form.

The Department will accept the submission of a template contract amendment if the sole purpose of the template is to convert the agreement to a VBP arrangement. The Department will follow up with Partially Capitated MLTC plans on the next VBP survey to determine which contracts were amended by use of an approved VBP template amendment.

2. New Contracts

Plans might choose to submit a new contract incorporating VBP requirements for use with providers. Plans should follow the 4255 contract guidelines in submitting these contracts, and incorporate VBP as detailed in this document.

To further assist with this process, DOH has provided resources and optional templates in the VBP Resource Library, located here:

Navigate towards the bottom of the page to find MLTC specific resources and contract amendment templates. Note, the use of these templates is optional.

If you have any additional questions or need assistance, feel free to reach out to