2018 Value Based Payment Reporting Requirements

Technical Specifications Manual

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

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New York State Department of Health
Email Address: vbp@health.ny.gov

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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
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Last revised October 31, 2017


2018 Value Based Payment Technical Specifications Manual

Table of Contents

I. SUBMISSION REQUIREMENTS

II. REPORTING REQUIREMENTS

III. FILE SPECIFICATIONS

IV. APPENDIX

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I. SUBMISSION REQUIREMENTS

Introduction

The purpose of this document is to make stakeholders aware of the quality measure reporting requirements for Medicaid Managed Care Organizations (MCOs) participating in the New York State Medicaid (NYS) VBP program. The 2018 Value Based Payment Reporting Requirements refer to 2017 Measurement Year (MY) data, except for Managed Long Term Care plans, for which the reporting requirements refer to 2018 MY data. Section II of the document includes guidance on the organizations responsible for reporting, the subset of measures for which reporting will be required by VBP Arrangement, and the changes to the reportable set of MY 2017 Quality Measure Sets (see the VBP Quality Measure tab) since the initial guidance was given in March of 2017.

The New York State Department of Health (NYS DOH) is mid–way through the first phase of a health transformation effort, known as the State Innovation Model (SIM) award, which focuses on transformation of primary care delivery and payment models statewide. The Advanced Primary Care (APC) model as part of the SIM initiative is intended to integrate a service delivery and reimbursement model to improve health quality outcomes that are financially sustainable. To reduce the burden on MCOs participating in both the APC model and Medicaid VBP, we are aligning the reporting for both programs and utilizing the APC Scorecard data request to fulfill reporting requirements for both programs. Section III describes File Specifications required for reporting. For more information on the State Health Innovation Plan, go here.

VBP Arrangements and Associated Quality Measures

The VBP Roadmap outlines five types of VBP arrangements to be included for MY 2017:

  • Total Care for the General Population (TCGP) Arrangement: Includes all costs and outcomes for care, excluding certain subpopulations (specified below).
  • Total Care for Special Needs Subpopulation Arrangements: Includes costs and outcomes of total care for all members within a subpopulation exclusive of TCGP.
    • Health and Recovery Plans (HARP): For those with Serious Mental Illness or Substance Use Disorders
    • HIV/AIDS
    • Managed Long Term Care (MLTC)
  • Episodic Care Arrangements:
    • Integrated Primary Care (IPC): Includes all costs and outcomes associated with primary care, sick care, and a set of chronic conditions selected due to high volume and/or costs.
  • Maternity Care: Includes episodes associated with a pregnancy, including prenatal care, delivery and postpartum care through 60 days post–discharge for the mother, and care provided to the newborn from birth through the first month post–discharge.

Categorization of Quality Measures

Through a multigroup stakeholder engagement process, a set of quality measures was defined for each arrangement. Based on an analysis of clinical relevance, reliability, validity, and feasibility, each measure was placed into one of three categories:

  • Category 1: Selected as clinically relevant, reliable, valid, and feasible. These measures are outlined in Table 1 below. REQUIREMENT: Only the Category 1 measures that are indicated in this document as "Required to Report" are to be reported by the MCO to the State.
  • Category 2: Seen as clinically relevant, valid, and likely reliable, but with problematic feasibility. Category 2 measures are listed in the appendix of this guide.
  • Category 3: Rejected based on a lack of relevance, reliability, validity, and/or feasibility. These measures are not included in this manual.

Classification of Quality Measures

Each measure is classified as either Pay–for–Performance (P4P) or Pay–for–Reporting (P4R). Pay–for– Performance measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. P4R measures are intended to be used by the MCOs to incentivize the VBP Contractors for reporting data to monitor quality of care delivered to members in a VBP contract.

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Organizations Required to Report

Medicaid Managed Care Organizations with Level 1 or higher value–based contracting arrangements or MCOs with a VBP Pilot contract are required to report.

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Reporting Requirement Guidelines

  • Table 1 lists, by arrangement, the 2017 VBP Category 1 Measure sets and indicates the 2017 measures the State is requiring for reporting.
  • Table 2 lists, by arrangement, the 2018 MLTC VBP Category 1 Measure set and indicates the 2018 measures required for reporting.
  • Section III describes File Specifications required for reporting.
    • This manual describes reporting requirements only. For VBP contracting questions, please contact bmcfhel@health.ny.gov
  • Organizations must purchase the HEDIS® 2018 Technical Specifications for descriptions of the required HEDIS® measures. For specifications for other non–HEDIS measures, please contact the measure steward for the correct version of the specification.
Specific Instructions per contracted VBP arrangement:

TCGP/IPC: The State is requesting that Medicaid Managed Care (MMC) plans submit data files that leverage their 2018 QARR (HEDIS) submission which will be used to create aggregated quality results by VBP Contractor. Specifically, the State is asking insurers to provide a modified version of NCQA´s Patient–Level Detail (PLD) file, along with provider and practice information. Submission of the Advanced Primary Care (APC) Scorecard file will fulfill this reporting requirement. The APC Patient–Level Detail File layout is included in Section III. A separate Patient Attribution file is not required for this arrangement.
Patient attribution is included in the APC Patient–Level Detail File.

Maternity: The State is requesting that MMC plans submit data files that leverage their 2018 QARR Live Birth Files. Include the provider/practice that was attributed to the member using your own plan´s attribution methodology for all members included in the 2018 QARR Live Birth File. Several fields regarding the provider and practice site of the service have been added to the layout request for this purpose. The Patient Attribution file layout is included in Section III.

HARP: HARP arrangements are required to report relevant TCGP/IPC measures and HARP–specific measures. The State is requesting that MMC plans submit data files that leverage their 2018 QARR (HEDIS) submission which will be used to create aggregated quality results by VBP Contractor. The State is asking plans to provide a modified version of NCQA´s Patient–Level Detail (PLD) file, along with provider and practice information. Submission of the Advanced Primary Care (APC) Scorecard file will fulfill the IPC reporting requirement. Additionally, the State is asking insurers to provide an attribution file for all members enrolled in your HARP arrangement. The attribution file will be used to link to the 2018 QARR Patient–Level Detail (PLD) file and NYS calculated measure results to create aggregate quality results for HARP–specific measures by VBP Contractor. The Patient Attribution file layout is included in Section III.

HIV/AIDS: HIV/AIDS arrangements are required to report relevant TCGP/IPC measures and HIV–specific measures. The State is requesting that MMC plans submit data files that leverage their 2018 QARR (HEDIS) submission which will be used to create aggregated quality results by VBP Contractor. The State is asking plans to provide a modified version of NCQA´s Patient–Level Detail (PLD) file, along with provider and practice information for all lines of business operating in New York. Submission of the Advanced Primary Care (APC) Scorecard file will fulfill the IPC reporting requirement. Additionally, the State is asking insurers to provide an attribution file for all members enrolled in your HIV/AIDS arrangement. The attribution file will be used to link to the 2018 NYS calculated measure results to create aggregate quality results for HIV–specific measures by VBP Contractor. The Patient Attribution file layout is included in Section III.

MLTC: The State is requesting insurers to submit a Patient Attribution file, which will be used to create aggregated quality results by VBP contractor. DOH will calculate all reportable Category 1 quality measure results for the arrangements. The attribution methodology and Patient Attribution file layout is included in Section III.

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Measure Changes

Changes to the Reporting Requirements for 2017 Measure Set were made based on the feedback received by the DOH from the Clinical Advisory Groups, Measure Support Task Force and Sub–teams, and from other stakeholder groups. Those changes are indicated below. In instances where a measure was moved from Category 1 in MY 2017 to Category 2 in MY 2018, the State will not require reporting of the data related to those measures.

TCGP/IPC:

  • Initiation of Pharmacotherapy for Alcohol Abuse and Dependence moved to Category 2
  • Use of Imaging Studies for Low Back Pain moved from Category 2 to Category 3
  • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis moved from Category 2 to Category 3

Maternity:

  • Frequency of Ongoing Prenatal Care measure was retired by NCQA and moved to Category 3.
  • LARC Uptake was renamed to "Contraceptive Care – Postpartum Women."

HARP:

  • Continuity of Care (CoC) within 14 Days of Discharge from Any Level of SUD Inpatient Care is now listed as two measures:
    1. Continuity of Care from Inpatient Detox to Lower Level of Care, and
    2. Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care
  • Rate of Readmission to Inpatient Mental Health Treatment within 30 Days was renamed to "Potentially Preventable Mental Health Readmission within 30 Days."

HIV/AIDS:

  • Renamed the measure "Proportion of Patients with HIV/AIDS that have a Potentially Avoidable Complication during a Calendar Year" to "Potentially Avoidable Complication (PAC) in Patients with HIV/AIDS."
  • Linkage to HIV Medical Care moved from Category 1 to Category 2.
  • Sexually Transmitted Diseases: Screening for Chlamydia, Gonorrhea, and Syphilis moved from Category 1 to Category 2.

MLTC:

  • Nursing Home Potentially Avoidable Hospitalization measure moved from Category 2 to Category 1.
  • The Nursing Home Category 2 measures moved from Pay for Reporting to Pay for Performance.
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New Measures

There were no new measures added to the 2017 measure set.

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Where to Submit VBP Reporting Data

  • Electronically submit all files (no later than 11:59p.m. ET on August 1, 2018) via a secure file transfer facility. Do not mail materials.
  • Specific delivery instructions are given for each file.
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What to Send for VBP Reporting

All submissions must be received electronically by 11:59 p.m. ET on August 1, 2018.

    Patient–Level Detail file: IPC, TCGP, HARP, HIV/AIDS

    Patient Attribution File: Maternity, HARP, HIV/AIDS, MLTC

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Questions Concerning 2018 VBP Reporting

Please submit all questions to vbp@health.ny.gov

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II. REPORTING REQUIREMENTS

Table 1: 2017 VBP List of Required Measures

Measures Notes Arrangement Type NQF ID Specifications Class
TCGP IPC Maternity HARP HIV/AIDS
Total Care for the General Population (TCGP)/ Integrated Primary Care (IPC)
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder   NR NR NA NR NR 1880 HEDIS 2018 P4P
Antidepressant Medication Management   4 4 NA NA 4 0105 HEDIS 2018 P4P
Breast Cancer Screening   4 4 NA 4 4 2372 HEDIS 2018 P4P
Cervical Cancer Screening 2 4 4 NA 4 4 0032 HEDIS 2018 P4P
Childhood Immunization Status   4 4 NA NA NA 0038 HEDIS 2018 P4P
Chlamydia Screening in Women   4 4 NA 4 NA 0033 HEDIS 2018 P4P
Colorectal Cancer Screening 2 4 4 NA 4 4 0034 HEDIS 2018 P4P
Comprehensive Diabetes Care: Eye Exams 2 4 4 NA 4 4 0055 HEDIS 2018 P4P
Comprehensive Diabetes Care: Foot Exam   NR NR NA NR NR 0056 HEDIS 2018 P4R
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) 2 4 4 NA 4 4 0575 HEDIS 2018 P4P
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) 2 4 4 NA 4 4 0059 HEDIS 2018 P4P
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing 2 4 4 NA 4 4 0057 HEDIS 2018 P4P
Comprehensive Diabetes Care: Medical Attention for Nephropathy 2 4 4 NA 4 4 0062 HEDIS 2018 P4P
Comprehensive Diabetes Screening: Received All Three Tests (HbA1c, Eye Exam, and Medical Attention for Nephropathy) 1 4 4 NA 4 4   NYS 2018 P4P
Controlling High Blood Pressure   NR NR NA NR NR 0018 HEDIS 2018 P4P
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Using Antipsychotic Medications   4 4 NA 4 4 1932 HEDIS 2018 P4P
Initiation and Engagement of Alcohol & Other Drug Abuse or Dependence Treatment   4 4 NA NA 4 0004 HEDIS 2018 P4P
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence   4 4 NA 4 4     P4P
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse and Dependence   NR NR NA NR NR      
Medication Management for People with Asthma   4 4 NA 4 4 1799 HEDIS 2018 P4P
Potentially Avoidable Complications (PAC) in Routine Sick Care or Chronic Care   NR NR NA NA NA   Altarum P4R
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow–Up Plan   NR NR NA NR NR 0421 CMS 2018 P4R
Preventive Care and Screening: Influenza Immunization   NR NR NA NR NR 0041 AMA v1.0 P4R
Preventive Care and Screening: Screening for Clinical Depression and Follow–Up Plan   NR NR NR NR NR 0418 CMS 2018 P4R
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention   NR NR NA NR NR 0028 AMA v1.0 P4R
Statin Therapy for Patients with Cardiovascular Disease   4 4 NA 4 4   HEDIS 2018 P4R
Statin Therapy for Patients with Diabetes   4 4 NA 4 4   HEDIS 2018 P4R
Use of Spirometry Testing in The Assessment and Diagnosis of COPD   4 4 NA 4 4 0577 HEDIS 2018 P4R
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents 2 4 4 NA NA NA 0024 HEDIS 2018 P4P
Maternity
Contraceptive Care – Postpartum Women   NA NA NR NA NA 2902 CMS 2018 P4R
C–Section for Nulliparous Singleton Term Vertex (NSTV)   NA NA NR NA NA 0471 TJC 2017 P4R
Frequency of On–Going Prenatal Care   NA NA NR NA NA      
Percentage of Babies Who Were Exclusively Fed with Breast Milk During Stay   NA NA NR NA NA 0408 TJC 2017 P4R
Incidence of Episiotomy [% of Vaginal Deliveries with Episiotomy]   NA NA NR NA NA 0470 NPIC P4R
Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full term)] 1 NA NA 4 NA NA 0278 AHRQ v7.0 P4R
Percentage of Preterm Births   NA NA NR NA NA   NYS 2018 P4R
Prenatal and Postpartum Care 2 NA NA 4 NA NA   HEDIS 2018 P4P
Health and Recovery Program (HARP)
Continuity of Care from Inpatient Detox to Lower Level of Care   NA NA NA 4 NA 1879 NYS 2018 P4P
Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care   NA NA NA 4 NA   NYS 2018 P4P
Follow–Up After Emergency Department Visit for Mental Illness   NA NA NA 4 NA 2605 HEDIS 2018 P4P
Follow–Up After Emergency Department Visit for Alcohol and Other Drug Dependence   NA NA NA 4 NA 2605 HEDIS 2018 P4P
Follow–Up After Hospitalization for Mental Illness   NA NA NA 4 NA 0576 HEDIS 2018 P4P
Maintaining/Improving Employment or Higher Education Status 1 NA NA NA 4 NA   NYS 2018 P4R
Maintenance of Stable or Improved Housing Status 1 NA NA NA 4 NA   NYS 2018 P4R
No or Reduced Criminal Justice Involvement 1 NA NA NA 4 NA   NYS 2018 P4R
Percentage of Members Enrolled in a Health Home 1 NA NA NA NR NA   NYS 2018 P4R
Percentage of Members who Receive PROS or HCBS for at least 3 Months in Reporting Year   NA NA NA NR NA   TBD  
Potentially Preventable Mental Health Related Readmission Rate 30 Days 1 NA NA NA 4 NA   NYS 2018 P4P
HIV/AIDS
Viral Load Suppression 1 NA NA NA NA 4   NYS 2018 P4P
Potentially Avoidable Complication (PAC) in Patients with HIV/AIDS 1 NA NA NA NA NR   Altarum P4R
Substance Abuse Screening   NA NA NA NA NR   NYS 2018 P4R

4 – Required to Report             NA – Not Applicable to the Arrangement             Shading (NR) – Purple– Not required to be reported
1 – There are no reporting requirements for this measure. NYS will calculate the measure result for MY 2017
2 – For measures that you may have reported using the hybrid sample in the PLD for QARR, we request that you
       report the administrative denominator and numerator for VBP.

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Table 2: 2018 MLTC VBP List of Required Measures

Measures Notes Arrangement Type NQF ID Specifications Class
MLTC
Managed Long Term Care (MLTC)
Percentage of members who did not have an emergency room visit in the last 90 days 1 4   NYS 2018 P4P
Percentage of members who did not have falls resulting in medical intervention in the last 90 days 1 4   NYS 2018 P4P
Percentage of members who received an influenza vaccination in the last year 1 4   NYS 2018 P4P
Potentially Avoidable Hospitalizations (PAH) for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection 1, 2 4   NYS 2018 P4P
Percentage of members who remained stable or demonstrated improvement in pain intensity 1 4   NYS 2018 P4P
Percentage of members who remained stable or demonstrated improvement in Nursing Facility Level of Care (NFLOC) score 1 4   NYS 2018 P4P
Percentage of members who remained stable or demonstrated improvement in urinary continence 1 4   NYS 2018 P4P
Percentage of members who remained stable or demonstrated improvement in shortness of breath 1 4   NYS 2018 P4P
Percentage of members who did not experience uncontrolled pain 1 4   NYS 2018 P4P
Percentage of members who were not lonely and not distressed 1 4   NYS 2018 P4P

4 – Required to Report             NA – Not Applicable to the Arrangement             Shading (NR) – Purple– Not required to be reported
1 – There are no reporting requirements for this measure. NYS will calculate the measure result for MY 2017
2 – NYS will calculate this measure for the community-based providers and the Nursing Homes separately.

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III. FILE SPECIFICATIONS

APC Scorecard Patient–Level Detail File

Please use your 2018 QARR/HEDIS data warehouse as the source for this information. Do not recalculate or update measure results. However, in addition to the measure elements that you reported for QARR/HEDIS in 2018, we are requesting that you include the provider/practice that was attributed to the member using your own plan´s attribution methodology for the IPC or TCGP arrangement. Several fields regarding the provider and practice site of the service have been added to the layout request for this purpose (Fields #6–20). This information has been added to allow us to aggregate the results by VBP Contractor across all New York State MCOs.

The APC data file is modeled after the HEDIS 2018 Patient–Level Detail file (PLD) that you prepared as part of your HEDIS submission, and many of the data elements in the APC file follow the same definitions and format as used to define the data elements in the HEDIS PLD. You may find it helpful to use the PLD as a resource or starting point in completing the APC file. We ask that you populate the PLD with all Lines of Business that you serve, e.g., Medicaid. Once completed, please upload the file to IPRO´s ftp site. A subfolder in the "QARR 2018" folder where you will upload your 2018 QARR files entitled "APC 2018" will be created for your submission. If someone other than your QARR liaison will be responsible for APC reporting, please contact Paul Henfield at the email address below for access to the FTP site.

Please note that the deadline for submission is Wednesday, August 1, 2018.

Exceptions to the PLD file are noted below:

  1. The APC file requests Medicare HEDIS data, which is not required for QARR reporting.
  2. The Plan ID is not your plan´s QARR ID. The Plan ID field should be populated with the Organization ID that you used to submit the IDSS to NCQA. Note that the Organization ID is different from the Submission ID, which is specific to a particular Line of Business. The Organization ID provides for six digits. If your plan´s ID is smaller, please right justify.
  3. The Childhood Immunization measure requires only a 0 or 1 for the numerator value while QARR requests the actual number of antigens provided. Also, we request that you provide the results for Combo 3 and not by antigen.
  4. For Medicaid, we ask that you populate the member´s CIN in the ID field; for other products, please use an internally–defined ID number.
  5. Provider/Practice attribution information is required for APC. Such information is not required for QARR.

Specific Instructions:

  1. Please be aware that although the member ID for all products except Medicaid is an internal number assigned by your plan, you will need to link the member to the provider of service. You should use a naming convention that will facilitate this process.
  2. If a member is reported for a specific measure in more than one product line (e.g., duals), please report them for only one product, using the following priority: Commercial, then Medicare, then Medicaid. This instruction affects only members who may be reported twice for the same service.
  3. A Unique Member ID (Field #3), may be included on the file more than once if the member is in more than one product line during the reporting period.
  4. For measures that you may have reported using the hybrid sample in the PLD, we request that you report the administrative denominator and numerator from the IDSS for APC.
  5. Members in the file must be in at least one measure.
  6. Measures that are not applicable to the member should be zero–filled.
  7. Practice Name must be populated in the Practice Name (Field #9) only.
  8. Practice Address Line 1 (Field #10) must contain the street address of the Practice, not the Practice Name.
  9. For Fields #6–20, leave these fields blank if the member cannot be attributed to any provider and you are not able to identify the provider.
  10. The IET Engagement numerator (Field #77 and 80) value must be less than or equal to the Initiation numerator (Field #76 and 79) value.
  11. For the AAB (Field #72) and LBP (Field #74) measures, provide the actual numerator (non–inverted), e.g., for AAB, the numerator would be members receiving the antibiotic.

For questions regarding this request, please contact Paul Henfield of IPRO at phenfield@ipro.org or 516–209–5670 or Ran Meng at ran.meng@health.ny.gov or 518–486–9012.

The APC Patient–Level Detail File Layout will be released at the end of November.
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Patient Attribution File

The State is asking insurers to provide an attribution file for all members enrolled in each arrangement per the methodology specified in your state–approved contract. The attribution file will be used to link to the 2018 NYS calculated measure results to create aggregate quality results for subpopulation–specific measures by VBP Contractor.

NOTE: MLTC attribution instructions are different than for other subpopulations. Follow the specified attribution methodology and file layout for each arrangement.

Attribution Methodology:
Maternity: Include the provider/practice that was attributed to the member using your own plan´s attribution methodology for all members included in the 2018 QARR Live Birth File.

HARP: Include the provider/practice that was attributed to the member using your own plan´s attribution methodology for all members included in any VBP Level 1 or higher arrangement.

HIV/AIDS: Include the provider/practice that was attributed to the member using your own plan´s attribution methodology for all members included in any VBP Level 1 or higher arrangement.

File format:
Element # Name Direction Allowed Values Required/Optional Length Start End
1 Plan ID# Organization ID used to submit the IDSS to NCQA. ###### = IDSS Organization ID R 6 1 6
2 Product Line A member´s product line at the end of the measurement period. 1 = MA
2 = SNP
3 = Medicare
4 = CPPO
5 = CHMO
6 = QHMO
7 = QPOS
8 = QPPO
9 = QEPO
10 = CEPO
11 = HARP
R 2 7 8
3 Unique Member ID# Medicaid Client ID Number (CIN)

The field is alphanumeric and should be treated as a text field. This field is mandatory – do not leave it blank!
  R 15 9 23
4 County of Residence Enter the 3–digit county FIPS code for each member´s residence of county. See the attachment for codes and values to enter here. ### = FIPS Code 000 = Outside of NYS R 3 24 26
5 Zip Code of Residence     R 5 27 31
6 Practice Tax ID#     R 10 32 41
7 PCMH Site ID# If available plan must include a PCMH Site ID# or an Internal plan practice site ID# (see element #8)   O 10 42 51
8 Practice Site ID# Internal plan practice site ID#   O 10 52 61
9 Practice Name     R 50 62 111
10 Practice Address Line 1     R 35 112 146
11 Practice Address Line 2     O 35 147 181
12 Practice Address Line 3     O 35 182 216
13 Practice Address City     R 25 217 241
14 Practice Address State     R 2 242 243
15 Practice Address Zip Code   ##### R 5 244 248
16 Practice Telephone Number   ########## O 10 249 258
17 Physician NPI     R 10 259 268
18 Physician First Name     R 15 269 283
19 Physician Middle Name     O 1 284 284
20 Physician Last Name     R 35 285 319

File Submission:
Files for the Maternity, HARP, HIV/AIDS arrangements are to be submitted to the New York State Department of Health via the Secure File Transfer 2.0 of the Health Commerce System. Files should be submitted to Lindsay Cogan (ljw02). Files are to be submitted by close of business on August 1, 2018.

For 2018, all reportable Category 1 measures for the MLTC arrangement will be computed by DOH to reduce the burden on MTLC plans and VBP contractors.

Attribution Methodology:

MLTC: Plan enrollees who have four or more months of continuous enrollment from April 2017 through June 2018 should be submitted in this attribution file. This attribution should be to provider organizations of CHHA, LHCSA, and SNF, which had the most frequent contact with the member and, therefore, could potentially affect the need for hospitalization or not.

File format:
  1. Include only members who had 4 months or more continuous enrollment in an MLTC plan from April 2017 through June 2018.
  2. For those meeting the criteria in step 1, provide at least one row for every member who was enrolled in the MLTC plan during the reporting period
  3. For each member from step 2, list all provider organization(s) that provided at least one service per month, for 4 or more continuous months from April 2017 through June 2018. The data should be formatted in a long form containing one row of data for each member/provider combination. Please provide one row of data for every provider a member was serviced by (see Example 2 below). If a member does not have any providers from which they received 4 or more continuous months of care, THE MEMBER SHOULD STILL BE LISTED (see example 1 below).
  4. The text file must be either: 1) fixed–width and named PROVIDERS_MLTC.TXT, or 2) comma separated values (CSV) and named PROVIDERS_MLTC.CSV.
    • Fixed–width files
      • Must have column start/end locations as documented in the following table.
      • Data must not include column names. The first row in the file must be data.
    • CSV files
      • Must not have additional columns beyond those shown in the following table.
      • Data must include column names. The first row in the file must be the column names as documented in the following table.
  5. The following table provides instructions on the submission of member–level data.
# Field Name Data Type Start
Column
Placement
End
Column
Placement
Details/Comments
1 CIN Varchar 1 8 A Participant´s Medicaid client identification number. The field should be continuous without any spaces or hyphens. The field is alpha– numeric and should be treated as a text field. This field may not be NULL.
2 MMIS_ID Varchar 9 16 The MLTC Plan´s numeric eight–digit ID. This field may not be NULL.
3 Prov_NPI Varchar 17 26 The unique 10–digit National Provider Identifier (NPI) for provider 1, by which the member was serviced by during the reporting period.
4 Prov_start_date Date 27 34 MMDDYYYY
5 Prov_end_date Date 35 42 MMDDYYYY
Field Definitions:

Prov_NPI: This is the unique 10–digit National Provider Identifier (NPI) of the provider the member was serviced by during the reporting period. This should be a provider organization which had frequent contact with the member and, therefore, could potentially affect the need for hospitalization or not. A member may be serviced by multiple providers during the same time period (provide one row of data for every provider a member was serviced by).

Prov_start_date: This is the service start date with the provider. This date must be during the reporting period. It should be in the format of MMDDYYYY with no intervening "–" or "/". The format is the same if data is submitted via a fixed–width file or CSV.

Prov_end_date: This is the service end date with the provider. This date must be during the reporting period. It should be in the format of MMDDYYYY with no intervening "–" or "/". The format is the same if data is submitted via a fixed–width file or CSV.

File Submission:
Files are to be submitted to the New York State Department of Health via the Secure File Transfer 2.0 of the Health Commerce System. Files should be submitted to Brian Bandle (short name bxb22) and Raina Josberger (short name rej03). Files are to be submitted by close of business on August 1, 2018.

Submission Examples:

Example 1:

The example below illustrates a member who was continuously enrolled for 4 or more months in the health plan, but did not receive least one service per month from a provider organization, for 4 or more continuous months from April 2017 through June 2018.

illustration of a member who was continuously enrolled for 4 or more months in the health plan, but did not receive least one service per month from a provider organization, for 4 or more continuous months from April 2017 through June 2018.

Example 2:

The example below illustrates two different providers, with overlapping services dates, aiding a single member from February through June 2018.

illustration of two different providers, with overlapping services dates, aiding a single member from February through June 2018
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IV. APPENDIX

Table 3: 2017 VBP List of Category 2 Measures

Measures Notes Arrangement Type NQF ID Measure Steward
IPC TCGP Maternity HARP HIV/AIDS
Integrated Primary Care (IPC)/ Total Care for the General Population (TCGP)
Asthma: Assessment of Asthma Control – Ambulatory Care Setting*   Cat 2 Cat 2 NA Cat 2 Cat 2   The American Academy of Allergy, Asthma & Immunology (AAAAI)
Continuing Engagement in Treatment (CET) Alcohol and other Drug Dependence   Cat 2 Cat 2 NA Cat 2 Cat 2   NYS TBD
Continuity of Care from Inpatient Detox to Lower Level of Care   Cat 2 Cat 2 NA Cat 2 Cat 2   NYS 2018
Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care   Cat 2 Cat 2 NA Cat 2 Cat 2   NYS 2018
Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (asthma)   Cat 2 Cat 2 NA Cat 2 Cat 2 0338 The Joint Commission
Lung Function/Spirometry Evaluation (asthma)   Cat 2 Cat 2 NA Cat 2 Cat 2   AAAAI
Patient Self–Management and Action Plan (asthma)   Cat 2 Cat 2 NA Cat 2 Cat 2   AAAAI
Topical Fluoride for Children at Elevated Caries Risk, Dental Services   Cat 2 Cat 2 NA Cat 2 Cat 2 2528 American Dental Association
Use of Pharmacotherapy for Alcohol Use Disorder   Cat 2 Cat 2 NA Cat 2 Cat 2 0034 NYS 2018
Use of Pharmacotherapy for Opioid Dependence   Cat 2 Cat 2 NA Cat 2 Cat 2 0055 NYS 2018
Maternity
Antenatal Hydroxyprogesterone   NA NA Cat 2 NA NA   TBD
Antenatal Steroids   NA NA Cat 2 NA NA 0476 TJC
Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery   NA NA Cat 2 NA NA 0473 Hospital Corporation of America
Experience of Mother with Pregnancy Care   NA NA Cat 2 NA NA   TBD
Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Discharge   NA NA Cat 2 NA NA 0475 Centers for Disease Control and Prevention
Intrapartum Antibiotic Prophylaxis for Group B Streptococcus (GBS)   NA NA Cat 2 NA NA 1746 Massachusetts General Hospital
Monitoring and Reporting of NICU Admission Rates   NA NA Cat 2 NA NA   TBD
Postpartum Blood Pressure Monitoring       Cat 2       TBD
Vaginal Birth After Cesarean (VBAC) Delivery Rate, Uncomplicated       Cat 2       AHRQ
Health and Recovery Program (HARP)
Percentage of Mental Health Discharges Followed by Two or More Mental Health Outpatient Visits within 30 Days   NA NA NA Cat 2 NA   NYS 2018
HIV/AIDS
Diabetes Screening   NA NA NA NA Cat 2   NYS DOH AIDS Institute
Hepatitis C Screening   NA NA NA NA Cat 2   HRSA
Housing Status   NA NA NA NA Cat 2   HRSA
Prescription of HIV Antiretroviral Therapy   NA NA NA NA Cat 2   HRSA
Sexual History Taking: Anal, Oral, and Genital   NA NA NA NA Cat 2   NYS DOH AIDS Institute
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Table 4. 2018 VBP MLTC Category 2 Measures

Measures Notes Arrangement Type Measure source/Steward
MLTC
Percentage of long stay high risk residents with pressure ulcers 1, 2 Cat 2 MDS 3.0 + /CMS
Percentage of long stay residents who received the pneumococcal vaccine 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents who received the seasonal influenza vaccine 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents experiencing one or more falls with major injury 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents who lose too much weight 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents with a urinary tract infection 1, 2 Cat 2 MDS 3.0/CMS
Care for Older Adults – Medication Review   Cat 2 NCQA
Use of High–Risk Medications in the Elderly   Cat 2 NCQA
Percentage of long stay low risk residents who lose control of their bowel or bladder 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents whose need for help with daily activities has increased 1, 2 Cat 2 MDS 3.0/CMS
Percentage of members who rated the quality of home health aide or personal care aide services within the last 6 months as good or excellent 3 Cat 2 MLTC Survey/New York State
Percentage of members who responded that they were usually or always involved in making decisions about their plan of care 3 Cat 2 MLTC Survey/New York State
Percentage of members who reported that within the last 6 months the home health aide or personal care aide services were always or usually on time 3 Cat 2 MLTC Survey/New York State
Percentage of long stay residents who have depressive symptoms 1, 2 Cat 2 MDS 3.0/CMS
Percentage of long stay residents with dementia who received an antipsychotic medication 1, 2 Cat 2 MDS 3.0/Pharmacy Quality Alliance
Percentage of long stay residents who self–report moderate to severe pain 1, 2   MDS 3.0 + /CMS

1 – Included in the NYS DOH Nursing Home Quality Initiative measure set
2 – MDS 3.0 denotes the Centers for Medicare and Medicaid Services Minimum Data Set for nursing home members
3 – Included in the NYS DOH MLTC Quality Incentive measure set

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