Value Based Payment (VBP)

This webpage provides an overview of relevant information related to NYS's VBP efforts. Questions related to VBP should be directed to vbp@health.ny.gov.

To ensure the long-term sustainability of the Delivery System Reform Incentive Payment (DSRIP) program investments in the 1115 waiver, the Terms and Conditions (§ 39) stated that NYS must submit a multi-year roadmap for comprehensive payment reform. The first Roadmap was submitted to the Centers for Medicare and Medicaid Services (CMS) and received approval on July 22, 2015. Each year until the expiration of DSRIP in March 2020, updates to the VBP roadmap were submitted and approved by CMS. Below are the annual approved versions of New York State's VBP Roadmap.

While NYSDOH has continued to support the goals and transition towards VBP, since the expiration of DSRIP, NYSDOH has not updated or refined the VBP Roadmap to reflect the current status of NYS's movement towards value based care and NYSDOH’s ongoing expectations. Accordingly, in the last quarter of 2021, NYSDOH reviewed and updated the VBP Roadmap to reaffirm its commitment to transition Managed Care Organizations (MCOs) and providers to a value based payment environment. This update to the VBP Roadmap condenses and clarifies the previous iteration and does not contain any material changes to the requirements of the program.On January 19, 2022, the draft updated VBP Roadmap was released for a 30-day public comment period. NYSDOH reviewed and analyzed each public comment submitted. A Public Comment Report, Executive Summary and Final Updated VBP Roadmap can be found below.

  • Final Documents
    • Final Executive Summary - (Web) - (PDF) - May 2022
    • Final Updated VBP Roadmap - (Web) - (PDF) - May 2022
  • Draft Documents
    • Draft Executive Summary - (Web) - (PDF) - January 2022
    • Draft Updated VBP Roadmap - (Web) - (PDF) - January 2022
  • Public Comment
    • Public Comment Report - (PDF) - May 2022
    • Public Notice - (Web) - (PDF) - January 2022
    • Public Comment Form - (XLSX) - January 2022
      • Updated VBP Roadmap Public Comment Educational Webinar - January 25, 2022

The VBP Workgroup is a broad stakeholder group that meets regularly to support the development of the VBP Roadmap.

  • VBP-U and VBP Bootcamps
  • The following videos provide an overview of what value based payments are, their important role in the NYS Medicaid program, how they will help to improve patient outcomes, and how VBP will reshape our healthcare system.

As outlined in the VBP Roadmap, the State has established a common set of quality measures for each VBP arrangement based on national standards and the recommendations from the Clinical Advisory Groups, Technical Design Subcommittees, and approved by the VBP Workgroup.

2022-2023 VBP Reporting Requirements Technical Specifications Manual.*NEW*

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 (NYS) Medicaid Value-Based Payment (VBP) program. The 2022-2023 VBP Reporting Requirements refer to data for Measurement Year 2022 (MY2022), except for Managed Long-Term Care plans, for which the reporting requirements refer to 2023 MY data.

Please fully read the updated VBP Reporting Requirements Technical Specifications Manual, any questions you may have can be sent to the New York State Department of Health VBP Unit at OQPSVBP@health.ny.gov.

  • 2022-2023 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual - (Web) - (PDF)
2023 VBP Quality Measure Sets *NEW*

The following Quality Measure Sets provide the listing of measures for the 2023 VBP contracting year including all Category 1 and Category 2 measures.

  • 2023 Behavioral Health/HARP Quality Measure Set - (Web) - (PDF)
  • 2023 Children's Quality Measure Set - (Web) - (PDF)
  • 2023 Maternity Quality Measure Set - (Web) - (PDF)
  • 2023 People Living with HIV/AIDs Quality Measure Set - (Web) - (PDF)
  • 2023 TCGP Quality Measure Set - (Web) - (PDF)
    • 2023 TCGP Measure Set list by Domain - (Web) - (PDF)
  • 2023 VBP MAP Quality Measure Set - (Web) - (PDF)
  • 2023 VBP PACE Quality Measure Set - (Web) - (PDF)
2022 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual.

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 2022 Value Based Payment Reporting Requirements refer to 2021 Measurement Year (MY) data, except for Managed Long-Term Care plans, for which the reporting requirements refer to 2022 MY data.

Please fully read the updated VBP Reporting Requirements Technical Specifications Manual, any questions you may have can be sent to the New York State Department of Health at OQPSVBP@health.ny.gov

  • 2022 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual - (Web) - (PDF)
2022 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2022 VBP contracting year including all Category 1 and Category 2 measures.

  • 2022 Children's Quality Measure Set - (Web) - (PDF)
  • 2022 Behavioral Health/HARP Quality Measure Set - (Web) - (PDF)
  • 2022 People Living with HIV/AIDs Quality Measure Set - (Web) - (PDF)
  • 2022 Maternity Quality Measure Set - (Web) - (PDF)
  • 2022 TCGP Quality Measure Set - (Web) - (PDF)
    • 2022 TCGP Measure Set list by Domain - (Web) - (PDF)
  • 2022 VBP MAP Quality Measure Set - (Web) - (PDF)
  • 2022 VBP PACE Quality Measure Set - (Web) - (PDF)
2021 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2020 VBP contracting year including all Category 1 and Category 2 measures.

2021 VBP Reporting Requirements Technical Specifications Manual.

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 (NYS) Medicaid VBP program. The 2021 Value Based Payment Reporting Requirements refer to Measurement Year (MY) 2020 data, except for Managed Long-Term Care plans, for which the reporting requirements refer to MY2021 data. The contents of this document include an overview of the specific reporting requirements for Category 1 Quality Measures for each VBP arrangement, detailed instructions regarding additional file specifications required for the VBP program, and examples of submission data. All questions can be sent to the New York State Department of Health at nysqarrhealth.ny.gov.

Please fully read the updated VBP Reporting Requirements Technical Specifications Manual as reporting requirements have significantly changed from prior years.

2020 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2020 VBP contracting year including all Category 1 and Category 2 measures.

Public Comment for 2020 VBP/QARR Measure Specifications [Comment Period Closed]

The New York State Department of Health is pleased to announce the public comment period is open for the draft technical specifications for newly proposed quality measures for both the 2020 Value Based Payment (VBP) Quality Measure Set and the 2020 Quality Assurance Reporting Requirements (QARR). The public comment period will occur for the next 30 days. We welcome your feedback on the proposed new measure and updates to existing measures. We are seeking specific comments to targeted questions per measure, as well as comments on whether you support, support with modifications, or do not support the use or change of this quality measure. Comments related to the measure intent and measure feasibility are also encouraged. The draft technical specifications document, the New York State Value Sets, and the Public Comment Submission Form links are posted below.

Comments and questions specifically relating to the measures should be submitted in writing via the Public Comment Submission Form to NYSQARR@health.ny.gov by December 20, 2019.

Reporting Guidance

2020 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. 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 (NYS) Medicaid VBP program. The 2020 Value Based Payment Reporting Requirements refer to Measurement Year (MY) 2019 data, except for Managed Long-Term Care plans, for which the reporting requirements refer to MY2020 data.The contents of this document include an overview of the specific reporting requirements for Category 1 Quality Measures for each VBP arrangement, detailed instructions regarding additional file specifications required for the VBP program, and examples of submission data. All questions can be sent to the New York State Department of Health at nysqarr@health.ny.gov.

Please fully read the updated VBP Reporting Requirements Technical Specifications Manual as reporting requirements have significantly changed from prior years.

2019 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2019 VBP contracting year including all Category 1 and Category 2 measures.

Public Comment for 2019 VBP/QARR Measure Specifications [Comment Period Closed]

The New York State Department of Health is pleased to announce the draft technical specifications for newly proposed quality measures for both the 2019 Value Based Payment (VBP) Quality Measure Set and the 2019 Quality Assurance Reporting Requirements (QARR). The public comment period will occur for the next 30 days. We welcome your feedback on the proposed new measures. We are seeking specific comments to targeted questions per measure, as well as comments on whether you support, support with modifications, or do not support the use of this quality measure. Comments related to the measure intent and measure feasibility are also encouraged. The draft technical specifications, the New York State Value Sets, and the Public Comment Submission Form are posted below. Comments and questions specifically relating to the measures should be submitted in writing via the Public Comment Submission Form to NYSQARR@health.ny.gov by December 21, 2018.

Reporting Guidance

2019 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. 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 (NYS) Medicaid VBP program. The contents of this document include an overview of the specific reporting requirements for Category 1 Quality Measures for each VBP arrangement, a description of the changes to the measure sets from Measurement Year 2018 to 2019, and detailed instructions regarding additional file specifications required for the VBP program. All questions can be sent to the New York State Department of Health at nysqarr@health.ny.gov.

Managed Long Term Care Value Based Payment Quality Measure Data Reporting Timeline

The Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline is a supplement to the 2019 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. The purpose of this document is to provide Partially Capitated MLTC Plans with a visual tool that outlines the timing of the data elements and information flow for VBP quality measurement.

2019 Quality Assurance Reporting Requirements (QARR) Technical Specifications Manual. The 2019 QARR Technical Specifications Manual can be found at the link below. This document contains the reporting requirements, listing of quality measures, and New York State-specific measure specifications as part of New York State's QARR program. Comments and questions relating to the manual should be submitted to nysqarr@health.ny.gov.

2018 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2018 VBP contracting year including all Category 1 and Category 2 measures.

Public Comment for 2018 VBP/QARR Measure Specifications [Comment Period Closed]

The New York State Department of Health is pleased to announce the draft technical specifications for newly proposed quality measures for both the 2019 Value Based Payment (VBP) Quality Measure Set and the 2019 Quality Assurance Reporting Requirements (QARR). The public comment period will occur for the next 30 days. We welcome your feedback on the proposed new measures. We are seeking specific comments to targeted questions per measure, as well as comments on whether you support, support with modifications, or do not support the use of this quality measure. Comments related to the measure intent and measure feasibility are also encouraged. The draft technical specifications, the New York State Value Sets, and the Public Comment Submission Form are posted below. Comments and questions specifically relating to the measures should be submitted in writing via the Public Comment Submission Form to vbp@health.ny.gov by September 11, 2017.

Managed Long Term Care Value Based Payment Quality Measure Data Reporting Timeline

The Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline is a supplement to the 2018 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. The purpose of this document is to provide Partially Capitated MLTC Plans with a visual tool that outlines the timing of the data elements and information flow for VBP quality measurement.

Managed Long Term Care - Use of the Potentially Avoidable Hospitalization (PAH) Measure for VBP Schematic

For MLTC plans and VBP Contractors, PAH measures help to assess whether a reduction in potentially avoidable hospital admissions among attributed members in VBP arrangements has occurred. The information depicted in below schematic explains how the PAH measures will be used in VBP.

Reporting Guidance

2018 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. 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 (NYS) Medicaid VBP program. The contents of this document include an overview of the specific reporting requirements for Category 1 Quality Measures for each VBP arrangement, a description of the changes to the measure sets from Measurement Year 2017 to 2018, and detailed instructions regarding additional file specifications required for the VBP program. All questions can be sent to the New York State Department of Health at vbp@health.ny.gov.

2018 Quality Assurance Reporting Requirements (QARR) Technical Specifications Manual. The 2018 QARR Technical Specifications Manual can be found at the link below. This document contains the reporting requirements, listing of quality measures, and New York State-specific measure specifications as part of New York State's QARR program. Comments and questions relating to the manual should be submitted to nysqarr@health.ny.gov.

VBP Quality Measure Sets

As outlined in the VBP Roadmap, the State has established a common set of quality measures for each VBP arrangement based on national standards and the recommendations from the Clinical Advisory Groups, Technical Design Subcommittees, and approved by the VBP Workgroup.

The following Quality Measure Sets provide the listing of measures for the 2017 VBP contracting year include all Category 1 and Category 2 measures.

Update 3/16/17: The links below include updates to the HARP and HIV/AIDS Quality Measure Sets due to the inclusion of measures from the Total Care for the General Population (TCGP)/Integrated Primary Care (IPC) Measure Set appropriate for these subpopulations. The Maternity Quality Measure Set also includes changes to the Category 2 measure list. Details for these changes are outlined in the Maternity Quality Measure Set document.

Update 5/9/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. The change relates to the measure Statin therapy for those with diabetes. The changes are redlined within the documents.

Update 6/15/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. This update reflects a modification to five measures addressing the initiation and utilization of medication-assisted treatment for alcohol and opioid dependence as well as the Continuity of Care Measure. The updated measure titles are redlined in the documents below.

Update 7/14/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. All updates are redlined within the documents.

The New York State (NYS) Department of Health (DOH) established the VBP Quality Measure Support Task Force, formerly known as the VBP Quality Measure Feasibility Task Force, to assist with assessment of quality measure data capture, calculation mechanisms, and reporting feasibility for the NYS VBP program. Task Force members represent Managed Care Organizations (MCOs), VBP Pilot Participants and Contractors, NYS DOH agencies, and other stakeholders with expertise in quality measurement and health information technology (HIT).

The Task Force is charged with soliciting and distilling feedback from VBP Contractors, MCOs, and VBP Pilots as it relates to quality measure feasibility, reporting, calculation and utility. Efforts also focus on developing strategies to assist with testing of new measures that require clinical data for calculation, aiding the NYS Department of Health in implementing best practices and further aligning quality measurement efforts statewide.

The Fact Sheets below provide an overview of each of the New York State Medicaid Value Based Payment Arrangements, including a high-level description of:

  • Types of care included in the arrangement,
  • Method used to define the attributed population for the arrangement,
  • Calculation of associated costs under the arrangement, and
  • Quality measures recommended for use in the arrangement.

Update 8/1/17: The Maternity Care Value Based Payment Fact Sheet has been updated to adhere to a new format.

New York State launched its' first Value Based Payment (VBP) Pilot in the fall of 2016 as one initiative to help the State reach the goal of having 80-90% of managed care payments to providers using value based payment methodologies by April 2020. The two-year program was designed to create momentum in the transition from fee-for-service to a value based payment environment, and provide valuable input into the design of VBP in New York State.

Six (6) provider organizations and eight (8) Managed Care Organizations (MCOs) located throughout the State have been working together as part of the Pilot Program on 12 distinct contracts. These contracts pilot three (3) types of value based payment arrangements: Health and Recovery Plan (HARP) Subpopulation, Integrated Primary Care (IPC), and Total Care for the General Population (TCGP).

These arrangements are contracted as per the standards outlined in the VBP Roadmap and pilot organizations have taken on downside risk-sharing VBP responsibilities this year. Pilot organizations have a critical role in evaluating the validity, feasibility, and reliability of quality measures for their respective arrangements, and also share feedback on core aspects of the VBP process (from contracting and financial risk sharing, to use of the Medicaid Analytics Performance Portal (MAPP) analytics).

For their pivotal role as early adopters, VBP pilot organizations receive support from the Department of Health, and in turn, they will provide early lessons learned and share best practices for statewide VBP implementation.

An additional value driven pilot launched in Albany County brings together pediatric providers and early childhood stakeholders with MCOs to focus on school readiness.

Participating VBP Pilot Organizations

Arrangement Provider MCO
HARP Maimonides Medical Center Healthfirst PHSP, Inc.
Mount Sinai Health Partners Healthfirst PHSP, Inc.
IPC Community Health IPA Affinity Health Plan, Inc.
TCGP Greater Buffalo United ACO Yourcare Health Plan, Inc.
Somos Your Health IPA Affinity Health Plan, Inc.
Somos Your Health IPA HealthPlus HP, LLC
Somos Your Health IPA New York State Catholic Health Plan, Inc.
Somos Your Health IPA Healthfirst PHSP, Inc.
Somos Your Health IPA United Healthcare of New York, Inc.
Somos Your Health IPA Wellcare of New York, Inc.
St. Joseph's Hospital Health Center New York State Catholic Health Plan, Inc.
St. Joseph's Hospital Health Center TotalCare/Molina Healthcare of New York, Inc.
School Readiness Albany County Pediatric Providers Capital District Physicians Health Plan, Inc.
MVP Health Care, Inc.
New York State Catholic Health Plan, Inc.
United Healthcare of New York, Inc.
Wellcare of New York, Inc.
Learning Diffusion
VBP Pilots "Early Lessons Learned" Webinars
Managed Long Term Care (MLTC)

The Managed Long Term Care, or MLTC, VBP Resources page houses content specifically related to the implementation of VBP in managed long term care. Information posted on the MLTC VBP Resources page will include guidance on VBP implementation for MLTC plans and providers, use of quality measures specific to MLTC, and contracting materials developed for public input such as measure specifications, Clinical Advisory Group publications, and surveys will also be posted on the MLTC VBP Resources page.

MLTC Clinical Advisory Group (CAG) Report for 2017

DOH is pleased to announce the release of the final MLTC CAG Report for 2017.

MLTC CAG Meetings

DOH is pleased to announce the release of the MLTC VBP CAG Meeting Presentation Slides.

VBP MLTC Guidance Documents for Fully Capitated Plans

The overall goal of the movement toward value based payment (VBP) in New York State's Medicaid program is to improve individual and population health outcomes by providing more integrated care, care coordination, and incentives for high quality care in a financially sustainable delivery system. The guidance documents below aim to support the understanding of VBP implementation for Medicaid Advantage Plus (MAP) Plans, Fully Integrated Duals Advantage (FIDA) Plans, and Program of All–Inclusive Care for the Elderly (PACE).

Comments and questions relating to the guidance documents should be submitted to MLTCVBP@health.ny.gov.

VBP Template Provider Amendments
VBP MLTC Stakeholder Meetings
*Feedback and comments relating to the proposed options for MLTC VBP Level 2 for partially capitated plans should be submitted to MLTCVBP@health.ny.gov no later than COB Friday, March 2, 2018 for consideration in strategy development.
VBP MLTC Learning Series
MLTC VBP Tracking Report (VBPTR)

The Centers for Medicare and Medicaid Services (CMS) has introduced an updated Quality Payment Program (QPP), which was included in the Medicare Access and CHIP Reauthorization Act (MACRA). The final rule posted in November of 2017 effects payments and reporting requirements for approximately 600,000 providers across the U.S. This section will serve as an introduction to the QPP requirements and highlights the alignment between the QPP and the NYS Value Based Payment Program.

MACRA Webinar - March 1, 2019
MACRA Webinar - June 13, 2018

After public review and comment, the Value Based Payment (VBP) Innovator Application Package has been finalized and posted to the VBP website. Applications for Innovator designation are now being accepted at any time on an ongoing basis. Please refer to the application and instructions in the below document titled: Final Innovator Program Overview and Application-June 2017.

The VBP Innovator Program will support experienced VBP contractors who are continuing to chart the path into value based payments. It is a voluntary program for VBP contractors prepared to participate in VBP Level 2 (full risk or near full risk) or Level 3 Total Care for General Population and/or Subpopulation arrangements. By taking on further management and administrative functions, contractors approved as Innovators will be eligible for an increased premium pass through. To become an Innovator, VBP contractors must provide all the information and documentation required in the application and explained in the instructions.

Final Innovator Program Application
Draft Innovator Program Documents - April 2017

In order to fully develop aspects of the Payment Reform and transition to VBP in NYS according to the vision laid out in the VBP Roadmap, two Workgroups were created to dive deeper into issues of Program Integrity and Patient Confidentiality. These workgroups functioned between September 2016 and December 2016.

What were Workgroups?
  • Workgroups play a crucial role in defining VBP implication details
  • Each workgroup was comprised of stakeholders who have direct interest in, and knowledge of, Program Integrity and/or Patient Confidentiality
  • Each workgroup had co-chairs charged with managing the workgroup's progress toward the development of a final Workgroup Recommendation Report
Workgroup Meeting Materials
Final Workgroup Recommendations

Through their efforts, each workgroup developed a list of recommendations to aid in the design and implementation of VBP in NYS. These recommendations are documented in full in the Recommendations Reports:

  • Bronx Equity Integrated Care for Kids New York (BE-InCK NY) Program Information and Notice - Coming Soon

Both the Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) have embarked on an ambitious journey to improve outcomes for patients and populations, reward the delivery of high value care by providers, and increase long-term financial sustainability. The Draft Medicare Alignment Paper presents an approach to maximally align CMS payment reform efforts for Medicare to the NYS Medicaid Payment Reform Roadmap. The proposal will continue to be developed with the input of the Value Based Payment Workgroup and other stakeholders including, but not limited to, NYS health plans, managed care organizations, provider associations, legal firms specializing in health care contracting, other state agencies, community-based providers, patient advocates, Performing Provider Systems and other industry experts.

A draft version of the NYS Medicaid Medicare VBP Alignment Paper was made available for public comment from August 4, 2015 until August 31, 2015. The consolidated list of public comments and the Draft Medicare Alignment Paper are below:

The alignment paper has been revised to include public comments and stakeholder feedback. The Final Draft NYS Medicaid Medicare VBP Alignment Paper has been submitted to CMS for their consideration. The letter to CMS and the revised Alignment Paper are below: