Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline

A Supplement to the VBP 2018 Reporting Requirements Technical Specifications Manual

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

January 2018

Introduction

  • MLTC plans and providers should review the annual guidance on VBP reporting posted on the New York State (NYS) Department of Health (DOH) website in the VBP Resource Library
    • The document – VBP 2018 Reporting Requirements Technical Specifications Manual – incorporates MLTC and provides quality measure reporting and data file format requirements including the attribution methodology
  • This document – a supplement to the manual – provides a visual timeline for data reporting through December 2020

Acronyms used in the document:

  • PAH denotes the Potentially Avoidable Hospitalizations quality measure
  • VBP QI denotes Value Based Payment Quality Indicators
  • SPARCS denotes Statewide Planning and Research Cooperative System
  • OQPS denotes Office of Quality and Patient Safety
  • MY denotes measurement year

NYSDOH VBP Resource Library is available here.

Key Concepts

  • Attribution – Connects members to providers/ VBP Contractors for the purpose of VBP quality measurement
    • Submitted annually to OQPS in August
    • Covers a 15–month enrollment period to the prior April (15 months is required to capture 3 months of continuous enrollment leading up to the month of July)
    • Attribution files will be used retrospectively for 6 months of prior–year quality measure calculation and prospectively for 6 months of current–year quality measure calculation, crossing 2 measurement years
  • Quality Measures Recommended for Use in VBP
    • Finalized and posted to DOH website in October in the Annual VBP Reporting Manual
    • PAH is calculated by New York State and captures a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection
      • PAH for community members will be calculated based on specific Plan/Provider–VBP Contractor attribution combinations
      • PAH for long–stay nursing home members will be calculated annually by facility
  • Rates and Payment – NYS will use VBP quality results to provide incentives for Plans and VBP Contractors
    • Quality results for MY 2018 will affect 2020–21 rates
    • Quality results for MY 2019 will affect 2021–22 rates
    • Quality results for MY 2020 will affect 2022–23 rates

Timeline Overview

Partially Capitated MLTC plans

Baseline Year
  • Plans submitted an attribution file in September 2017 for July – December 2016 PAH rates
    • PAH Rates for July – December 2016 data were sent back to plans in October/November 2017
  • There was also a one–time request for plans to submit an additional attribution file in February 2018 for January – June 2017 PAH rates
    • Preliminary Community PAH rates for January – June 2017 data will be released in March 2018
    • Final rates that include data for the January – December 2017 PAH measurement period (for both Community and Nursing Home) and the July 2016 – June 2017 VBP QI will be released in October 2018
MY 2018
  • Plans will submit an attribution file in August 2018 to cover 15 months of plan/provider enrollment (April 2017 – June 2018)
  • Preliminary Community PAH Rates for January – June 2018 data will be released in March 2019
  • Final rates that include data for the January – December 2018 PAH measurement period (for both Community and Nursing Home) and the July 2017 – June 2018 VBP QI will be released in October 2019

*Note: The process for MY 2019 and MY 2020 follow the same pattern as MY 2018

MLTC VBP Quality Measure Data Reporting Timeline

Partially Capitated MLTC plans

MLTC VBP Quality Measure Data Reporting Timeline

Please submit all questions to: mltcvbp@health.ny.gov

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