VBP for Managed Long Term Care (MLTC) Plans

FAQs: VBP Post-DSRIP for MLTC Plans (Partial, MAP, PACE) November 20, 2020

• FAQs also available in Portable Document Format (PDF)

Purpose: This FAQ document is designed to address questions related to the implementation of VBP arrangements for Managed-Long Term Care (Partial, MAP, PACE) plans in response to the expiration of DSRIP in New York State.

Additional questions may be submitted to the VBP mailbox (VBP@health.ny.gov) with "MLTC FAQ" in the subject line.

What is the Department´s expectation for Level 1 & 2 MLTC partial contracts?

A: Given the initiatives to promote integrated care for dual eligible and its impact MLTC Partial (MLTCP) plans from the enacted SFY 2020-21 Budget, the Department encourages MLTCP plans to examine the outcomes and impacts of their current VBP contracts upon expiration and to make an informed determination as to whether such arrangements should be renewed or expanded, or whether to enter into new VBP arrangements. Beyond this encouragement, the Department is not imposing any broader expectations on MLTCP plans and understands that determinations will be made individually by MLTCP plans in collaboration with their providers.

What is the Department´s expectation for MAP and PACE VBP contracts?

A: The Department encourages plans to continue to submit VBP arrangements for MAP & PACE consistent with standards outlined in the VBP Roadmap and the Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs . The Department will continue to review VBP arrangements and approve as VBP (level 1, 2, or 3) or non-VBP accordingly.

What is the deadline for and turnaround time for approval for revised 2020 amendments?

A: The Department will accept VBP amendments on a rolling basis as plans deem necessary for renewal. The Department will continue to review and approve contracts following the timeframes outlined in the Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs.

Will plans still be subject to penalties if the 15% threshold identified in the VBP Roadmap is not met or maintained?

A: Due to the impact of COVID-19 on performance metrics and the expiration of DSRIP, the Department will not impose penalties at this time. However, the principles and standards of the VBP Roadmap remain the same for plans that elect to enter into VBP arrangements.

As we begin planning our 2021 arrangements, what are the plan requirements for the NYSDOH VBP program? Are they the same as 2020?

A: MAP & PACE plans should continue to enter into and submit VBP contracts following standards outlined in the VBP Roadmap and the Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs. Changes to measures sets for 2021 for MAP & PACE will be presented and reviewed at the next MLTC CAG meeting (details to follow). Please also see email communications regarding the PAH measure that were sent to MLTC plans on August 27, 2020 and September 17, 2020.