New Requirements for TCGP Quality Measure Reports

October 4, 2019

New Requirements for Mainstream Medicaid Managed Care Plans Engaging in Total Care for the General Population Value Based Payment Contracts

  1. All Total Care for the General Population (TCGP) Value–Based Payment (VBP) contracts submitted on or after January 1, 2020 must include at least one Category 1 Pay–For–Performance (P4P) measure from each of the following domains of the TCGP quality measure set:
    1. Primary Care Domain;
    2. Mental Health Domain;
    3. Substance Use Disorder Domain;
    4. HIV/AIDS Domain;
    5. Maternity Care Domain; and the
    6. Children’s Domain.
  2. All existing TCGP VBP contracts which do not include a measure from each of the domains above must be amended to include, at least one Category 1 Pay– For–Performance (P4P) measure from each of the domains listed above, and submitted at the end of the contract’s current measurement period and before the contract’s next measurement period begins, or no later than January 1, 2021.

TCGP VBP arrangements that exclude or carve out maternity, children, or HIV/AIDS are not required to include quality measures from the maternity, children, or HIV/AIDS quality measure set domains. TCGP arrangements that carve out HARP members are still required to include quality measures from the primary care, mental health, and substance use disorder quality measure domains, in addition to the maternity, children, and HIV/AIDS domains if these latter populations are included.

The 2020 TCGP quality measure set, with its representative domains, is posted on–line in the DSRIP – VBP Resource Library web page.

The new VBP quality measure requirements are contained in the NYS VBP Roadmap updates. The newly updated VBP Roadmap establishes the model for NYS VBP going forward. For a complete overview of all updates to the NYS VBP model, please view the 2019 NYS VBP Roadmap.