VBP QIP Demonstration Year 3 Guidance Document
- Timeline is also available in Portable Document Format (PDF)
Updated as of 3/17/17
Table of Contents
Purpose
The purpose of this document is to provide Value Based Payment Quality Improvement Program (VBP QIP) participants information to progress into the third demonstration year (DY3) of the program. This document is designed to be useful to both Group 1 and Group 2 participants. This document should be considered as a supplement to other programmatic documents released by DOH, including guidance documents, frequently asked questions, presentations, etc. Included in this document are:
- Recap of the VBP QIP overview, roles and expectations, etc.
- Overview of VBP QIP DY3 requirements
- Summary of other VBP QIP DY3 activities
- Explanation of VBP QIP DY3 payments
- Illustration of the DY3 pairings table
- Overview of the DY3 timeline
- Outline of DY3 reporting table, including submission information.
Recap: VBP QIP Overview
| Theme | State Guidance |
|---|---|
| Program purpose and compliance | VBP QIP´s purpose
The purpose of VBP QIP is to transition financially distressed Facilities to a VBP model, improve their quality of care, and as a result of improved quality and VBP contracting, achieve financial sustainability over the duration of the Program. The Program´s purpose is not to sustain current operations, but to ensure long–term financial sustainability through active changes in the delivery and contracting of healthcare services. VBP QIP is not VAPAP As stated above, the purpose of VBP QIP is not to solely sustain facility operations, like its predecessor program, VAPAP, was designed to do. If a partner finds that their paired partners are not making efforts to meet their responsibilities within the Program, then DOH should be notified to help ensure participant compliance with the Program. Additionally, it should be noted that VBP QIP is a voluntary program and the State may take action to ensure that the all participants meet their respective responsibilities. VBP QIP and compliance At the initiation of the VBP QIP, NYS Medicaid Director, Jason Helgerson, issued a formal letter to Program participants stating that the Program is in compliance with State and Federal regulations. The State stands by this letter and affirms that the design of the program and the payments that have been made for this program to date are in compliance as implemented. The State will continue to monitor the program to ensure its continued compliance with State and Federal law. |
| Participant Roles | The MCO´s role in VBP QIP Dy3
|
| Reporting and Monitoring Requirements | Reporting in VBP QIP Program participants should abide by the arrangements in their VBP QIP contracts, Facility Plans, and Governance Documents for reporting on their progress towards Program milestones. If a deliverable or report is not submitted, the State should be notified to help ensure participant compliance within VBP QIP. By start of DY3, Facility Plans will be finalized and Facilities will be expected to work towards program milestones and report on their progress in order to receive payment. Similar to DSRIP, once a Facility meets its milestones, the Facility is awarded a performance payment to aid in its transformation. The MCO is not responsible for auditing the VBP QIP payments or the use of funds earned by the Facility. The MCO´s responsibility is to oversee the Facility´s progress throughout the duration of VBP QIP. MCOs will issue reports to DOH tracking payment amounts to facilities. These MCO reports to DOH should also include documentation of paired facilities progress towards meeting VBP QIP performance measures and documentation demonstrating success in entering into VBP contracts. |
| Funds Flow | Funding for VBP QIP It is the State´s commitment to ensure that MCOs have adequate resources to distribute Program funding without making MCOs advance their own funds prior to receiving monies from the State. MCOs should notify the DOH immediately if they recognize a difference between their actual and expected monthly premium payments. Additionally, MCOs should only release funds when a Facility successfully meets its metrics as well as other reporting and contractual agreements for that period. |
| Governance and Contracting Expectations | VBP QIP Governance Plan Purpose Each MCO participating in VBP QIP must submit a Governance Plan. The purpose of the Governance Plan is to ensure program integrity and formalized lines of accountability and communication among participating MCOs, PPS, and Facilities. All program participants are expected to abide by their contractual obligations, as well as, the guidance stated in the Governance Plan. VBP QIP contracts and contract extensions The State expects MCOs, PPS, and Facilities to either renew contracts over the course of the Program or create a contract that lasts for the Program´s duration. |
VBP QIP DY3 Requirements
In DY3, 50% of payments will be based on P4R deliverables and 50% of payments will be based on P4P deliverables. Below is a high–level summary of deliverables for DY3 of VBP QIP. For detailed information on DY3 deliverables, please refer to the VBP QIP Facility Plan Guidance Document available on the VBP QIP website.
DY3 Q1 Requirements
100% of the DY3 Q1 payment is tied to P4R.
| Quarter 1 (April 1, 2017 – June 30, 2017) | |
|---|---|
| Metric | P4R/P4P |
| Provide a Letter of Intent (LOI)* for at least one Level 1 VBP Contract that will be executed by July 1, 2017. *LOI may be substituted by a Contract Attestation if a Level 1 VBP contract already exists by April 1, 2017 | P4R |
| Provide an MCO Contract List that includes calendar year 2015 Managed Care revenue from cost reports for each Medicaid Managed Care contract the facility had in that year. The facility should also include projections for which VBP contracts will have a TCGP value–based arrangement by April 1, 2018. | P4R |
DY3 Q2 Requirements
100% of the DY3 Q2 payment is tied to P4R.
| Quarter 2 (July 1, 2017 – September 30, 2017) | |
|---|---|
| Metric | P4R/P4P |
| Sign at least one Level 1 VBP contract and provide a Contract Attestation | P4R |
| Provide LOIs* with the remaining Medicaid MCOs needed to meet the 80% VBP contracting target (as outlined in the updated MCO Contract List) *LOI may be substituted by a Contract Attestation if a Level 1 VBP contract already exists by July 1, 2017 | P4R |
| Provide an updated MCO Contract List with calendar year 2016 Medicaid Managed Care revenue from cost reports and VBP arrangement information. MCO Contract List should be accompanied by an attestation confirming the accuracy of the data by a senior manager at the facility. | P4R |
DY3 Q3 Requirements
100% of the DY3 Q3 payments is based on P4P.
| Quarter 3 (October 1, 2017 – December 31, 2017) | |
|---|---|
| Metric | P4R/P4P |
| Facilities to submit baselines (rolling annual baseline covering DY2 Q4 that will be used for DY3 Q1 measurement) for all selected VBP QIP P4P measures to the paired MCO | P4P |
DY3 Q4 Requirements
100% of the DY3 Q4 payment is based on P4P.
| Quarter 4 (January 1, 2018 – March 31, 2018) | |
|---|---|
| Metric | P4R/P4P |
| Facilities to submit measure results for all selected VBP QIP P4P measures related to the measurement period that occurred in DY3 Q1 to the paired MCO | P4P |
DY3 P4P Timeline Illustration
The figure below illustrates the DY3 P4P timeline.
VBP QIP DY3 Payments
As described in the DY3 Requirements section above, VBP QIP payments in DY3 are for both Pay for Performance (P4P) and Pay for Reporting (P4R) activities. Specifically, in DY3, 50% of payment will be based on reporting on VBP contracting progress (P4R) and 50% on actual performance improvement (P4P) on a facility’s selected quality measures. In the first two quarters of DY3, funds will be paid solely for P4R and in the remaining two quarters of DY3 funds will be solely for P4P. Although performance in P4R and P4R aspects determine the overall amount of payment for the quarter, payments are still expected to be made on a monthly basis.
Annual Payment Distribution
| DY3 | DY4 | DY5 | |
|---|---|---|---|
| VBP Contracting Progress (P4R) % | 50% (Paid in Q1 & Q2) | 20% | 0% |
| Performance Improvement (P4P) % | 50% (Paid in Q3 & Q4) | 80% | 100% |
Quarterly Payment Distribution
| DY3 | ||||
|---|---|---|---|---|
| Q1 | Q2 | Q3 | Q4 | |
| VBP Contracting Progress (P4R) % | 25% | 25% | ||
| Performance Improvement (P4P) % | 25% | 25% | ||
*All percentages are a proportion of annual payments
|top of section| |top of page|Other VBP QIP DY3 Activities
In addition to the VBP QIP DY3 requirements, there are other items participants should monitor that take place in DY3 and are due in future years. This section outlines the other P4R and P4P activities that facilities should continue to work on in DY3 to help achieve metrics for future years. Additionally, this section outlines potential P4R penalties for facilities that do not meet DY3 P4R requirements.
Other P4R Activities
The last P4R requirements in DY3 are due on July 1, 2017. However, facilities should continue to work toward Level 1 VBP contracts aligned to LOIs submitted to meet their additional P4R requirement on April 1, 2018. By April 1, 2018, VBP QIP facility must have Medicaid MCO contracts where at least 80% of total Medicaid MCO contracted payments (based on the 2016 data reported in the July 1, 2017 MCO Contract List) to the facility are tied to at least Level 1 value based purchasing components.
Other P4P Activities
The figure below outlines P4P activities that should take place during DY3 related to QIT. Participants should note that there are P4P activities, such as data collection, data review, etc., that are tied to payments in future years that should take place in DY3. Additionally, some payments in DY4 are tied to measurement periods in DY3.
1 – Facilities will report their initial baseline for DY2 Q4. Therefore, there is no measurement associated with this quarter.
In addition to QIT activities, facilities should consider activities during DY3 related to the DY4 AIT as outlined in the graphic below.
Potential DY3 P4R Penalties
Facilities that do not meet P4R requirements in DY3 are subject to penalties outlined below.
| DY | Penalties | % of Total P4R Payment in DY |
|---|---|---|
| 3 | DY3 Q1 Payment: Tied to P4R milestones due April 1, 2017 | Penalty if Not Met: Up to 50% of P4R Funds in DY3 |
| DY3 Q2 Payment: Tied to P4R milestones due July 1, 2017 | Penalty if Not Met: Up to 50% of P4R Funds in DY3 |
VBP QIP DY3 Pairings Table
The most current pairings are outlined below.*
| MCO | PPS | Facility |
|---|---|---|
| Affinity | Maimonides Medical Center | Brookdale Hospital |
| Montefiore Hudson Valley Collaborative | St. Joseph´s Hospital | |
| Amerigroup | Nassau Queens Performing Provider System, LLC | Nassau University Medical Center |
| Emblem Health (HIP) | Health and Hospitals Corp. | Health and Hospitals Corp. |
| Excellus | Central New York Collaborative, Inc. | Lewis County General Hospital |
| Finger Lakes Performing Provider Systems, Inc. | St. James Mercy Hospital | |
| Orleans Community Hospital | ||
| Wyoming County Community Health | ||
| Mohawk Valley PPS | A O Fox Memorial Hospital | |
| Fidelis | Maimonides Medical Center | Interfaith Medical Center |
| Kingsbrook Jewish Medical Center | ||
| Montefiore Hudson Valley Collaborative | Montefiore–Mount Vernon | |
| Nyack Hospital | ||
| Nassau Queens Performing Provider System, LLC | St. John´s Episcopal | |
| Westchester Medical Center | Bon Secours Charity Health | |
| Good Samaritan Hospital Suffern | ||
| HealthFirst | Maimonides Medical Center | Brookdale Hospital |
| MetroPlus | Health and Hospitals Corp. | Health and Hospitals Corp. |
| MVP | Montefiore Hudson Valley Collaborative | Montefiore – New Rochelle |
| Westchester Medical Center | Health Alliance (Benedictine) | |
| United Health Plan | Central New York Care Collaborative, Inc. | Rome Memorial Hospital |
| Maimonides Medical Center | Wyckoff Heights Medical Center | |
| WellCare | Montefiore Hudson Valley Collaborative | St. Luke´s Cornwall |
* Pairings are subject to change.
|top of section| |top of page|VBP QIP DY3 Timeline
Please note that the dates included herein are the Department’s recommended completion dates for past, present, and upcoming VBP QIP milestones. It is up to individual pairings of VBP QIP partners to determine the exact completion dates for each of the following items. To successfully participate in VBP QIP and to continue to receive payments, these milestones must be met and reported on in the proper order as detailed below. Please keep in mind that VBP QIP is a performance–based program and there should never be prospective payments; participants should only receive funds once VBP QIP objectives for the payment period are met. Exact timing is left to the discretion of the MCO as program administrator in coordination with its paired PPS and Facilities unless otherwise noted by the State. Please note that dates highlighted in red must be completed by their listed times and cannot be delayed.
| Milestone | Due Date |
|---|---|
| Governance Document | |
| MCOs to make updates to the Governance Plans as appropriate (copies must be sent to DOH) | Ongoing |
| Facility Plan | |
| MCOs to make updates to the Facility Plans as appropriate (copies must be sent to DOH) | Ongoing |
| Pay for Reporting (P4R): VBP Contracting | |
| Facilities must provide paired MCO and DOH with a Letter of Intent (LOI) for at least one VBP contract by July 1, 2017 (LOI may be substituted with a Contract Attestation if a VBP contract already exists by April 1, 2017) | April 1, 2017 |
| Facilities must provide DOH (only) with the MCO Contract List of current Medicaid Managed Care Contracts including 2015 cost data for each Medicaid Managed Care contract the facility has and should also include projections for which VBP contracts will have a Total Care for General Population (TCGP) value–based arrangement by April 1, 2018 | April 1, 2017 |
| Facilities must provide paired MCO and DOH with at least one Contract Attestation confirming parties intend to sign a VBP contract in accordance with the NYS Roadmap | July 1, 2017 |
| Facilities must provide paired MCO and DOH with LOIs with the remaining Medicaid MCOs for VBP contracts by April 1, 2018 (LOI may be substituted with Contract Attestations if a VBP contract already exist by July 1, 2017) | July 1, 2017 |
| Facilities must provide DOH (only) with the updated MCO Contract List of current Medicaid Managed Care Contracts including 2016 cost data for each Medicaid Managed Care contract the facility has and should also include projections for which VBP contracts will have a TCGP value–based arrangement by April 1, 2018 | July 1, 2017 |
| Facilities must provide paired MCO and DOH with a signed Facility Attestation related to 2016 cost data reported in the Medicaid MCO list | July 1, 2017 |
| Facilities continue to execute contracts to meet deadline by April 1, 2018 | July 1, 2017 to March 31, 2018 |
| DOH to review and file submitted VBP contracts | Ongoing: review period depends on risk level of the VBP contract |
| Pay for Performance (P4P): VBP QIP Quality Measurement | |
| DOH to release the statewide mean for measures for DY4 for AIT measurement | June 2017 |
| Facilities to submit P4P measures to their paired MCOs | Quarterly: Beginning DY3 Q3, no later than 120 days after close of Quarter |
| MCOs to review and approve reports | Quarterly: Beginning DY3 Q3, no later than 45 days after initial submission |
| MCOs to notify facilities of decision prepare monthly payments | Quarterly: Beginning DY3 Q3, no later than 180 days after close of Quarter |
| Reporting | |
| MCO Quarterly Reporting to DOH (April 2016 – Ongoing) – MMCOR Submissions | Ongoing: 45 days after Quarter End |
| Facilities report on selected measures on quarterly basis | Ongoing: Quarterly |
VBP QIP DY3 Reporting
| Report | Submitted by | Submitted to | Frequency | Location |
|---|---|---|---|---|
| VBP QIP Contracts | MCOs | DOH | As updated | vbp_qip@health.ny.gov |
| Approved Facility Plans | MCOs | DOH | March 31, 2017 | vbp_qip@health.ny.gov |
| 1 LOI or Contract Attestation | Facilities | MCOs & DOH | April 1, 2017 | vbp_qip@health.ny.gov |
| MCO Contract List with 2015 data | Facilities | DOH | April 1, 2017 | vbp_qip@health.ny.gov |
| 1 Contract Attestation for Level 1 VBP | Facilities | MCOs | July 1, 2017 | |
| Remaining LOIs (or Contract Attestations) | Facilities | MCOs & DOH | July 1, 2017 | vbp_qip@health.ny.gov |
| MCO Contract List with 2016 data and Facility Attestation | Facilities | DOH | July 1, 2017 | vbp_qip@health.ny.gov |
| Remaining Contract Attestations | Facilities | MCOs & DOH | April 1, 2018 | vbp_qip@health.ny.gov |
| Documentation of achievement of P4P metrics | Facilities | MCOs | Quarterly | |
| Documentation of approval of P4P deliverables and supporting documentation | MCOs | DOH | Quarterly | vbp_qip@health.ny.gov |
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