2020 Value Based Payment Reporting Requirements
Technical Specifications Manual
- Manual is also available in Portable Document Format (PDF)
_______________________________________________________________________
New York State Department of Health
Email Address: nysqarr@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 February 11, 2020
2020 Value Based Payment Technical Specifications Manual
Table of Contents
I. SUBMISSION REQUIREMENTS
- INTRODUCTION
- VBP ARRANGEMENTS AND ASSOCIATED QUALITY MEASURES
- CATEGORIZATION OF QUALITY MEASURES
- CLASSIFICATION OF QUALITY MEASURES
- ORGANIZATIONS REQUIRED TO REPORT
- REPORTING REQUIREMENT GUIDELINES
- MEASURE CHANGES
- NEW MEASURE
II. REPORTING REQUIREMENTS
III. FILE SPECIFICATIONS
- NYS PCMH SCORECARD PATIENT-LEVEL DETAIL FILE
- SPECIFIC INSTRUCTIONS
- PATIENT ATTRIBUTION FILE
- MLTC ATTRIBUTION FILE
- ATTRIBUTION METHODOLOGY:
IV. Appendix
- Table 3: 2019 VBP List of Category 2 Measures
- Table 4. 2019 VBP MLTC Category 2 Measures
- Table 5 - NYS FIPS Codes by County
- Table 6: Submission Examples
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 2020 Value Based Payment Reporting Requirements refer to 2019 Measurement Year (MY) data, except for Managed Long-Term Care plans, for which the reporting requirements refer to 2020 MY data. Section II of this 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 MY2019 Quality Measure Sets (see the VBP Quality Measure tab).
The New York State Department of Health (NYS DOH) is approaching the completion of the first phase of a health transformation effort, known as the State Innovation Model (SIM) award, which focused on the transformation of primary care delivery and payment models statewide. The New York State Patient Centered Medical Home (NYS PCMH) model was created as part of the SIM initiative. With NYS PCMH, a Primary Care Core measure set was developed, and multi-payer data is used to calculate results for practices for the measure. To reduce the burden on MCOs participating in both the NYS PC measure set model and Medicaid VBP, we are aligning the reporting for both programs and utilizing the NYS Primary Care Core Set Scorecard data request to fulfill reporting requirements for both programs, where possible. Section III of this manual describes File Specifications required for VBP reporting. For more information on the State Health Innovation Plan, go here.
VBP ARRANGEMENTS AND ASSOCIATED QUALITY MEASURES
The VBP Roadmap outlines six types of VBP arrangements to be included for MY2019:
- 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 30 days post-discharge.
CATEGORIZATION OF QUALITY MEASURES
Through a multi-group 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 reliable, but where the feasibility could be problematic. 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 Category 1 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. At least one Category 1 P4P measure must be included in a VBP contract.
|table of contents|ORGANIZATIONS REQUIRED TO REPORT
Medicaid Managed Care Organizations with Level 1 or higher value-based contracting arrangements are required to report. All submissions must be received electronically by 11:59 p.m. ET on Monday, August 3, 2020.
|table of contents|REPORTING REQUIREMENT GUIDELINES
- Table 1: 2019 VBP List of Required Measures
- Lists, by arrangement, the 2019 VBP Category 1 Measure sets and indicates the 2019 measures the State is requiring for reporting.
- Table 2: 2020 MLTC VBP List of Required Measures
- Lists, by arrangement, the 2020 MLTC VBP Category 1 Measure set and indicates the 2020 measures required for reporting.
- Section III: File Specifications required for reporting.
- This manual describes reporting requirements only. For VBP reporting questions, please contact nysqarr@health.ny.gov. For VBP contracting questions, please contact vbp@health.ny.gov.
- Organizations must purchase the HEDIS® 2020 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. NYS specific measures are defined in the 2020 Quality Assurance Reporting Requirements (QARR) Technical Specifications Manual.
SPECIFIC INSTRUCTIONS PER CONTRACTED VBP ARRANGEMENT:
Mainstream & Subpopulation VBP Arrangements: (other than MLTC) The State is requesting that Medicaid Managed Care (MMC) plans submit data files that leverage their 2020 QARR (HEDIS) submission which will be used to create aggregated quality results by VBP Contractor for all members in a VBP Arrangement. Specifically, the State is asking insurers to provide a modified version of NYS Patient-Level Detail (PLD) file, along with provider and practice information. Submission of the NYS Patient Centered Medical Home (PCMH) Patient Level Detailed file for all members in a Level 1 or higher VBP Arrangement will fulfill this reporting requirement. The NYS PCMH Patient-Level Detail File layout is included in Section III of this manual. The State is also requesting a separate Patient Attribution file for all members in a Level 1 or higher VBP Arrangement. The Patient Attribution file layout is also 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 Provider or 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.
|table of contents|MEASURE CHANGES
Changes to the Reporting Requirements for 2019 Measure Sets 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 MY2019 to Category 2 in MY2020 or removed entirely, the State will not require reporting of the data related to those measures.
TCGP:
Category 1: Changes
- No Category 1 Measures were removed from the TCGP measure set.
Category 2: Changes
- Continuity of Care from Inpatient Detox to Lower Level of Care; removed as a Category 2 Measure.
- Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care; removed as a Category 2 Measure.
IPC:
Category 1: Changes
- No Category 1 Measures were removed from the IPC measure set.
Category 2: Changes
- Continuity of Care from Inpatient Detox to Lower Level of Care; removed as a Category 2 Measure.
- Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care; removed as a Category 2 Measure.
HARP:
Category 1: Changes
- Continuity of Care from Inpatient Detox to Lower Level of Care; removed as a Category 1 Measure.
- Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care; removed as a Category 1 Measure.
Category 2: Changes
- No Category 2 Measures were removed from the HARP measure set.
HIV/AIDS:
Category 1: Changes
- No Category 1 Measures were removed from the HIV/AIDs measure set.
Category 2: Changes
- Continuity of Care from Inpatient Detox to Lower Level of Care; removed as a Category 2 Measure.
- Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care; removed as a Category 2 Measure.
Maternity:
Category 1: Changes
- No Category 1 Measures were removed from the Maternity measure set.
Category 2: Changes
- Monitoring and Reporting of NICU Referral Rates; removed as a Category 2 Measure.
MLTC:
Category 1: Changes
- Percentage of members who did not have an emergency room visit in the last 90 days; resumed as a Measure.
NEW MEASURES
TCGP:
Category 1: Changes
- Asthma Medication Ratio; added as a Category 1 Measure.
- Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full term)]; added as a Category 1 Measure.
- Prenatal and Postpartum Care; added as a Category 1 Measure.
Category 2: Changes
- Depression Remission or Response for Adolescents and Adults; added as a Category 2 Measure.
IPC:
Category 1: Changes
- Asthma Medication Ratio; added as a Category 1 Measure.
Category 2: Changes
- Depression Remission or Response for Adolescents and Adults; added as a Category 2 Measure.
HARP:
Category 1: Changes
- Asthma Medication Ratio; added as a Category 1 Measure.
Category 2: Changes
- No Category 2 Measures were added to the HARP measure set.
HIV/AIDS:
Category 1: Changes
- Asthma Medication Ratio; added as a Category 1 Measure.
Category 2: Changes
- Depression Remission or Response for Adolescents and Adults; added as a Category 2 Measure.
Maternity:
Category 1: Changes
- Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment; added as a Category 1 Measure.
- Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention; added as a Category 1 Measure.
Category 2: Changes
- No Category 2 Measures were added to the Maternity measure set.
MLTC:
Category 1: Changes
- No Category 1 Measures were added to the MLTC measure set.
Category 2: Changes
- No Category 2 Measures were added to the MLTC measure set.
Where to Submit VBP Reporting Data
- Electronically submit all files (no later than 11:59p.m. ET on Monday, August 3, 2020) via a secure file transfer facility. Do not mail materials.
- Specific delivery instructions are given for each file.
What to Send for VBP Reporting
What to Send for VBP Reporting
- The State is requesting a NYS PCMH file and a Patient Attribution file for ALL members in a VBP Level 1 or higher Arrangement.
- Exception: The NYS PCMH file is not required for MLTC.
***** All submissions must be received electronically by 11:59 p.m. ET on Monday, August 3, 2020. *****
|table of contents|Questions Concerning 2020 VBP Reporting
Please submit all questions to nysqarr@health.ny.gov
|top of section| |table of contents|II. REPORTING REQUIREMENTS
TABLE 1: 2019 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 | NA | NR | 1880 | HEDIS 2019 | P4P | |
| Adolescent Preventive Care Measures | 2 | NR | NR | NA | NA | NA | NYS 2019 | P4R | |
| Adolescent Well-Care Visits | ✓ | ✓ | NA | NA | NA | HEDIS 2019 | P4R | ||
| Annual Dental Visit | ✓ | ✓ | NA | NA | NA | 1388 | HEDIS 2019 | P4R | |
| Antidepressant Medication Management | ✓ | ✓ | NA | NA | ✓ | 105 | HEDIS 2019 | P4P | |
| Asthma Admission Rate (PDI #14) | NR | NR | NA | NA | NA | 728 | AHRQ | P4P | |
| Asthma Medication Ratio | ✓ | ✓ | NA | ✓ | ✓ | 1800 | HEDIS 2019 | P4P | |
| Breast Cancer Screening | ✓ | ✓ | NA | ✓ | ✓ | 2372 | HEDIS 2019 | P4P | |
| Cervical Cancer Screening | 2 | ✓ | ✓ | NA | ✓ | ✓ | 32 | HEDIS 2019 | P4P |
| Childhood Immunization Status - combination 3 | 2 | ✓ | ✓ | NA | NA | NA | 38 | HEDIS 2019 | P4P |
| Chlamydia Screening in Women | ✓ | ✓ | NA | ✓ | NA | 33 | HEDIS 2019 | P4P | |
| Colorectal Cancer Screening | 2 | ✓ | ✓ | NA | ✓ | ✓ | 34 | HEDIS 2019 | P4P |
| Comprehensive Diabetes Care: Eye Exams | 2 | ✓ | ✓ | NA | ✓ | ✓ | 55 | HEDIS 2019 | P4P |
| Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) | 2 | ✓ | ✓ | NA | ✓ | ✓ | 59 | HEDIS 2019 | P4P |
| Comprehensive Diabetes Care: Medical Attention for Nephropathy | 2 | ✓ | ✓ | NA | ✓ | ✓ | 62 | HEDIS 2019 | P4P |
| Controlling High Blood Pressure | 2 | ✓ | ✓ | NA | ✓ | ✓ | 18 | HEDIS 2019 | P4P |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Using Antipsychotic Medications | ✓ | ✓ | NA | ✓ | ✓ | 1932 | HEDIS 2019 | P4P | |
| Follow-Up Care for Children Prescribed ADHD Medication | ✓ | ✓ | NA | NA | NA | 108 | HEDIS 2019 | P4R | |
| Immunizations for Adolescents - Combination 2 | ✓ | ✓ | NA | NA | NA | 1407 | HEDIS 2019 | P4P | |
| Initiation and Engagement of Alcohol & Other Drug Abuse or Dependence Treatment | ✓ | ✓ | ✓ | ✓ | ✓ | 4 | HEDIS 2019 | P4P | |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | ✓ | ✓ | NA | ✓ | ✓ | NYS 2019 | P4P | ||
| Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full term)] | ✓ | NA | ✓ | NA | NA | 278 | AHRQ v7.0 | P4R | |
| Medication Management for People with Asthma | ✓ | ✓ | NA | ✓ | ✓ | 1799 | HEDIS 2019 | 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 | 421 | CMS 2019 | P4R | |
| Preventive Care and Screening: Influenza Immunization | NR | NR | NA | NR | NR | 41 | AMA PCPI | P4R | |
| Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan | NR | NR | NR | NA | NR | 418 | CMS 2019 | P4R | |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | NR | NR | ✓ | NR | NR | 28 | AMA PCPI | P4R | |
| Statin Therapy for Patients with Cardiovascular Disease | ✓ | ✓ | NA | ✓ | ✓ | HEDIS 2019 | P4R | ||
| Use of Pharmacotherapy for Alcohol Abuse or Dependence | ✓ | ✓ | NA | ✓ | ✓ | NYS 2019 | P4R | ||
| Use of Spirometry Testing in the Assessment and Diagnosis of COPD | ✓ | ✓ | NA | ✓ | ✓ | 577 | HEDIS 2019 | P4R | |
| Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents | 2 | ✓ | ✓ | NA | NA | NA | 24 | HEDIS 2019 | P4P |
| Well-Child Visits in the First 15 Months of Life | ✓ | ✓ | NA | NA | NA | 1392 | HEDIS 2019 | P4P | |
| Well-Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life | ✓ | ✓ | NA | NA | NA | 1516 | HEDIS 2019 | P4P | |
| Maternity | |||||||||
| Contraceptive Care - Postpartum | NA | NA | NR | NA | NA | 2902 | US Office of Population Affairs | P4R | |
| C-Section for Nulliparous Singleton Term Vertex (NSTV) | NA | NA | NR | NA | NA | 471 | TJC 2019 | P4R | |
| Exclusively Breast Milk Feeding | NA | NA | NR | NA | NA | 480 | TJC 2017 | P4R | |
| Incidence of Episiotomy | NA | NA | NR | NA | NA | 470 | Christiana Care Health System | P4R | |
| Percentage of Preterm Births | NA | NA | NR | NA | NA | NYS 2019 Vital Statics | P4R | ||
| Prenatal and Postpartum Care | ✓ | NA | ✓ | NA | NA | NQF 1517 (lost endorsement) | HEDIS 2019 | P4P | |
| Health and Recovery Program (HARP) | |||||||||
| Adherence to Antipsychotic Medications for Individuals with Schizophrenia | NA | NA | NA | ✓ | NA | 1879 | CMS 2018 | P4P | |
| Follow-Up After Emergency Department Visit for Mental Illness | NA | NA | NA | ✓ | NA | 2605 | HEDIS 2019 | P4P | |
| Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence | NA | NA | NA | ✓ | NA | 2605 | HEDIS 2019 | P4P | |
| Follow-Up After Hospitalization for Mental Illness | NA | NA | NA | ✓ | NA | 576 | HEDIS 2019 | P4P | |
| Maintaining/Improving Employment or Higher Education Status | 1 | NA | NA | NA | ✓ | NA | NYS 2019 | P4R | |
| Maintenance of Stable or Improved Housing Status | 1 | NA | NA | NA | ✓ | NA | NYS 2019 | P4R | |
| No or Reduced Criminal Justice Involvement | 1 | NA | NA | NA | ✓ | NA | NYS 2019 | P4R | |
| Percentage of Members Enrolled in a Health Home | 1 | NA | NA | NA | NR | NA | NYS 2019 | P4R | |
| Potentially Preventable Mental Health Related Readmission Rate 30 Days | 1 | NA | NA | NA | ✓ | NA | NYS 2019 | P4P | |
| HIV/AIDS | |||||||||
| HIV Viral Load Suppression | 1 | NA | NA | NA | NA | ✓ | 2082 | HRSA | P4P |
| Potentially Avoidable Complication (PAC) in Patients with HIV/AIDS | 1 | NA | NA | NA | NA | NR | Altarum | P4R | |
| Sexually Transmitted Infections: Screening for Chlamydia, Gonorrhea, and Syphilis | 1 | NA | NA | NA | NA | ✓ | NYS 2019 | P4P | |
✓ - 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 MY2019
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 nu merator for VBP.
TABLE 2: 2020 MLTC VBP LIST OF REQUIRED MEASURES
| Measures | Notes | Arrangement Type MLTC |
NQF ID | Specifications | Class |
|---|---|---|---|---|---|
| Managed Long Term Care (MLTC) | |||||
| Percentage of members who did not experience falls that resulted in major or minor injury in the last 90 days | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who received an influenza vaccination in the last year | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who remained stable or demonstrated improvement in pain intensity | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who remained stable or demonstrated improvement in Nursing Facility Level of Care (NFLOC) score | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who remained stable or demonstrated improvement in urinary continence | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who remained stable or demonstrated improvement in shortness of breath | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who did not experience uncontrolled pain | 1 | ✓ | NYS 2020 | P4P | |
| Percentage of members who were not lonely or were not distressed | 1 | ✓ | NYS 2020 | P4P | |
| Potentially Avoidable Hospitalizations (PAH) for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection | 1, 2 | ✓ | NYS 2020 | P4P | |
✓ - 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 MY2019/2020
2 - NYS will calculate this measure for the community-based providers and the Nursing Homes separately.
III. FILE SPECIFICATIONS
NYS PCMH SCORECARD PATIENT-LEVEL DETAIL FILE
Please use your 2020 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 2020 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, specifically two separate fields for TIN: Practice TIN and Contractor TIN. In addition to Contractor TIN as health plans contract with different types of entities, such as providers, hospital systems, Independent Practice Associations (IPAs), and Accountable Care Organizations (ACOs) we have added a Contractor Type field. This information has been added to allow us to aggregate the results by VBP Contractor across all New York State MCOs.
The NYS PCMH data file is modeled after the NYS 2020 Patient-Level Detail file (PLD) that you prepared as part of your QARR submission, and many of the data elements in the NYS PCMH file follow the same definitions and format as used to define the data elements in the PLD. You may find it helpful to use the PLD as a resource or starting point in completing the NYS PCMH file. We ask that you populate the NYS PCMH 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 2020" folder where you will upload your 2020 QARR files entitled "NYS PCMH 2020" will be created for your submission. If someone other than your QARR liaison will be responsible for NYS PCMH reporting, please contact Margaret Morris at the email address below for access to the FTP site. Please note that the deadline for submission is Monday, August 3, 2020.
Exceptions to the PLD file are noted below:
- The NYS PCMH file requests Medicare HEDIS data, which is not required for QARR reporting.
- 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. Submission ID which is specific to a Line of Business.
- The Organization ID provides for six digits. If your plan´s ID is smaller, please right justify.
- For Medicaid, we ask that you populate the Member´s CIN in the ID field.
- The field is alphanumeric and should be treated as a text field. This field is mandatory - do not leave it blank!
- Provider/Practice attribution information is required for NYS PCMH. This information is not required for QARR reporting.
SPECIFIC INSTRUCTIONS:
- 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.
- 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.
- For measures that you may have reported using the hybrid sample in the NYS PLD, we request that you report the administrative denominator and numerator from the IDSS for NYS PCMH.
- Members in the file must be in at least one measure.
- Measures that are not applicable to the member should be zero-filled.
- A valid Tax ID (TIN) is nine characters. If the TIN is not available, set the field value to "999999999."
- Practice Name must be populated in the Practice Name (Field #9) only.
- Practice Address Line 1 (Field #10) must contain the street address of the Practice, not the Practice Name.
- For Fields #7-22, leave these fields blank if the member cannot be attributed to any provider and you are not able to identify the provider.
- For Field # 21, Populate with valid TINs only. If member is NOT attributed to a VBP Contractor set to '999999999'.
- The IET Engagement numerator ( Field #88 and 91) value must be less than or equal to the Initiation numerator (Field #87 and 90) value.
- For the AAB (Field #83) and LBP (Field #85) measures, provide the actual numerator (non-inverted), e.g., for AAB, the numerator would be members receiving the antibiotic.
- For the AMB measure (Field #92), please populate the fields with the number of events for each LOB you are reporting. Member Months is not required for 2020.
- For the IPU/AHU/EDU measures (Fields #93-96 and Fields #128-131), please populate the fields with number of events for each LOB you are reporting. Member Months is not required for 2020.
- The ADD Continuation and Maintenance (C&M) Phase denominator (Field #104) and numerator (Field #105) must be less than or equal to the Initiation Phase denominator (Field #102) and numerator (Field #103).
- IMA has been added in fields 100-101. IMA has one numerator: Combo 2. Report the administrative denominator and numerator.
- ADD has been added in fields 102-105. ADD has two numerators: Initiation Phase and Continuation and Maintenance (C&M) Phase.
- ADV has been added in fields 106-117. ADV has six numerators: 2-3 years, 4-6 years, 7-10 years, 11-14 years, 15-18 years, and 19-20 years.
- W15 has been added in fields 118-120. W15 has two numerators: Five Well-Child Visits and Six or more Well-Child Visits.
- W34 has been added in fields 121-122.
- AWC has been added in fields 123-124.
- COL has been added in fields 125-126. Report the administrative denominator and numerator.
- CBP has been added in fields 127-128. Report the administrative denominator and numerator.
- Only MCOs reporting their Medicaid line of Business need report the following 9 VBP specific measures: Statin therapy for patients with cardiovascular disease, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Diabetes Screening for Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications, Initiation of Pharmacotherapy upon New Episode of Opioid Dependence, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (Administrative rate), Follow-Up Care for Children Prescribed ADHD Medication, Annual Dental Visit, Well-Child Visits in the First 15 Months of Life, and Adolescent Well-Care visits. Medicaid plans submitting NYS PCMH data should add these additional variables to the NYS PCMH file layout and it will count towards the VBP reporting requirements.
For questions regarding this request, please contact Margret Morris of IPRO at mmorris@ipro.org or 516-589-3988.
The NYS PCMH Patient-Level Detail File Layout will be released in mid-December.
|table of contents|PATIENT ATTRIBUTION FILE
The State is asking insurers to provide an attribution file for all members enrolled in a VBP arrangement per the methodology specified in your state-approved contract. The attribution file will be used in combination with other quality measure sources (e.g. 2020 NYS Patient-Level Detail File) to aggregate quality results for the 2019 Category 1 population-specific measures by VBP Contractor.
NOTE: MLTC attribution instructions are different than for other populations. Please follow the instructions in the MLTC attribution file subsection of this manual.
|table of contents|FILE FORMAT:
Submit a text file that is either: fixed-width (TXT) or comma separated values (CSV)
Fixed-width TXT 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.
- Numeric values should be right justified, and blank filled to the left of the value; text fields should be left- justified, and blank filled to the right of the value. Variable character (VARCHAR) fields should be treated as text.
CSV files:
- Must not have additional columns beyond those shown in the following table. (Refer to companion excel file.)
- Data must include column names. The first row in the file must be the column names as documented in the following table.
Naming Convention:
The file should be named VBP_PlanID_2019.txt or VBP_PlanID_2019.cvs (Refer to field 1 in table below.)
All files are due no later than Monday, August 3, 2020.
| Element # | Name | Direction | Allowed Values | Data Type | Required/ Optional | Length | Start | End |
|---|---|---|---|---|---|---|---|---|
| 1 | Plan_ID# | Organization ID used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business. | ###### | VARCHAR | R | 6 | 1 | 6 |
| 2 | Product_Line | A member´s product line at the end of the measurement period. | 1 = MEDICAID 2 = SNP 11 = HARP |
NUMBER | R | 2 | 7 | 8 |
| 3 | Unique_Member_ ID# | Medicaid Client ID Number (CIN) *The field is alphanumeric and should be treated as text field. This field is mandatory - do not leave it blank! | VARCHAR | R | 8 | 9 | 16 | |
| 4 | County_of_ Residence | Enter the 3-digit county FIPS code for each member´s residence of county. | ### | NUMBER | R | 3 | 17 | 19 |
| 5 | Zip_Code_of_ Residence | ##### | NUMBER | R | 5 | 20 | 24 | |
| 6 | Practice_Tax_ID# | Populate with valid TINs only. This field is mandatory - do not leave it blank! | ######### | NUMBER | R | 9 | 25 | 33 |
| 7 | PCMH_Site_ID# | PCMH Site ID# - NCQA generated ID | NUMBER | O | 11 | 34 | 44 | |
| 8 | Practice_Site_ID# | Internal plan practice site ID# | VARCHAR | O | 13 | 45 | 57 | |
| 9 | Practice_Name | This field is mandatory - do not leave it blank! | TEXT | R | 50 | 58 | 107 | |
| 10 | Practice_Address_ Line_1 | TEXT | R | 35 | 108 | 142 | ||
| 11 | Practice_Address_ Line_2 | TEXT | O | 35 | 143 | 177 | ||
| 12 | Practice_Address_ Line_3 | TEXT | O | 35 | 178 | 212 | ||
| 13 | Practice_Address_ City | TEXT | R | 25 | 213 | 237 | ||
| 14 | Practice_Address_ State | TEXT | R | 2 | 238 | 239 | ||
| 15 | Practice_Address_ Zip_Code | ##### | NUMBER | R | 5 | 240 | 244 | |
| 16 | Practice_Telephone _Number | ########## | NUMBER | O | 10 | 245 | 254 | |
| 17 | Provider_NPI | National Provider Identifier - 10 Digit ID | ########## | NUMBER | R | 10 | 255 | 264 |
| 18 | Provider_First_ Name | TEXT | R | 15 | 265 | 279 | ||
| 19 | Provider_Middle_ Initial | TEXT | O | 1 | 280 | 280 | ||
| 20 | Provider_Last_ Name | TEXT | R | 35 | 281 | 315 | ||
| 21 | VBP_Contractor_ Tax_ID# | Populate with valid TINs only. If member is NOT in a VBP level 1 or higher arrangement set to ´999999999´. | ######### | NUMBER | R | 9 | 316 | 324 |
| 22 | VBP_Contractor_ DBA_Name | Enter the DBA name listed on your VBP contract/arrangement. | VARCHAR | R | 50 | 325 | 374 | |
| 23 | VBP_Contractor_ Type | 1 = Provider/ Hospital 2 = IPA 3 = ACO 9 = Unknown | NUMBER | R | 1 | 375 | 375 | |
| 24 | VBP_Arrangement_ Type | Refer to Section C, #2b of the DOH 4255 - Provider Contract Statement and Certification form. | 1 = TCGP 2 = IPC 3 = HARP 4 = HIV/AIDs 5 = Maternity 6 = Off Menu | NUMBER | R | 1 | 376 | 376 |
| 25 * | DOH_VBP_Contract _ID# | Number provided by DOH in Agreement approval letter, begins with DOH ID ### | #### | NUMBER | R | 4 | 377 | 380 |
| 26 * | MCO_Unique_ Contract_ID# | Plan generated ID used to submit contract to DOH; Section A, #3 of the 4255. | VARCHAR | R | 50 | 381 | 430 | |
| 27 | Prov_Att_start_date | MMDDYYYY - Must be between 1/1/2019 and 12/31/2019 | MMDDYYYY | DATE | R | 8 | 431 | 438 |
| 28 | Prov_Att_end_date | MMDDYYYY - Must be between 1/1/2019 and 12/31/2019 | MMDDYYYY | DATE | R | 8 | 439 | 446 |
FIELD DEFINITIONS:
| # | Field Name | Description/Specifications |
|---|---|---|
| 1 | Plan_ID# | Enter your Organization ID used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business. |
| 2 | Product_Line | Enter the member´s product line at the end of the measurement period . Enter the corresponding number (1) Medicaid, (2) SNP, (11) HARP. |
| 3 | Unique_Member_ID# | Enter member´s Medicaid Client Identification Number (CIN). 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 is mandatory - do not leave it blank! |
| 4 | County_of_Residence | Enter the Federal Information Processing Standard (FIPS) code for the member´s county of residence. Please refer to Appendix IV, Table 5 - NYS FIPS Codes by County at the end of this manual for a complete listing of NYS FIPS codes. |
| 5 | Zip_Code_of_Residence | Enter the 5-digit zip code of the member´s residence. |
| 6 | Practice_Tax_ID# | Enter the 9-digit Federally assigned Tax Identification number for the Practice of the member´s provider. Populate with valid TINs only. This field is mandatory - do not leave it blank! |
| 7 | PCMH_Site_ID# | Enter the NCQA assigned number associated with your Patient-Centered Medical Home (PCHM.) |
| 8 | Practice_Site_ID# | Enter your internal site ID assigned by the plan. |
| 9 | Practice_Name | Enter the complete name of the provider´s practice. This field is required, do not leave blank. |
| 10 | Practice_Address_Line_1 | Enter the physical address of the practice location. (Enter up to 3 lines) |
| 11 | Practice_Address_Line_2 | |
| 12 | Practice_Address_Line_3 | |
| 13 | Practice_Address_City | Enter the city in which the practice is located. |
| 14 | Practice_Address_State | Enter the 2-digit abbreviation for the state in which the practice is located. |
| 15 | Practice_Address_Zip_Code | Enter the 5-digit zip code in which the practice is located. |
| 16 | Practice_Telephone_Number | Enter the practice´s main phone line, it should be in the format of ########## with no intervening "-". |
| 17 | Provider_NPI | This is the unique 10-digit National Provider Identifier (NPI) of the provider themember was serviced by during the reporting period. This should be a providerorganization which had frequent contact with the member and, therefore, couldpotentially affect the need for hospitalization or not. A member may be serviced bymultiple providers during the same time period (provide one row of data for everyprovider a member was serviced by). |
| 18 | Provider_First_Name | Enter the provider full first name |
| 19 | Provider_Middle_Initial | Enter the provider´s middle initial. |
| 20 | Provider_Last_Name | Enter the provider´s last name. |
| 21 | VBP_Contractor_Tax_ID# | This is the unique 9-digit tax identification number of the VBP Contractor (not theprovider) that the member is assigned to for a Level 1 or higher VBP arrangementduring the reporting period. A member can only be assigned to one VBP contactor ata time. If not applicable, fill with 999999999. |
| 22 | VBP_Contractor_DBA_Name | The "Doing Business As" (DBA) name is the operating name of a company, asopposed to the legal name of the company. The VBP Contractor may be an ACO, IPA, individual provider or hospital. |
| 23 | VBP_Contractor_Type | In this field, enter ´1´ if the contractor is a provider (provider includes hospitals), ´2´ if the contractor is an IPA, ´3´ if the contractor is an ACO, ´9´ if Unknown |
| 24 | VBP_Arrangement_Type | In this field, enter "1" if the VBP arrangement type is a TCGP arrangement, "2" if it is an IPC arrangement, "3" if it is a HARP arrangement, "4" if it is an HIV/AIDsarrangement, "5" if it is a Maternity arrangement, "6" if it is an Off Menuarrangement. This information can be found in Section C, #2b of the DOH 4255 - Provider Contract Statement and Certification form . |
| 25 * | DOH_VBP_Contract_ID# | This is the number provided by DOH in the Agreement approval letter for your VBP arrangement, it begins with DOH ID ####. *You must populate either field 25 or 26,preferably both fields should be populated. |
| 26 * | MCO_Unique_Contract_ID# | This is the contract identifier created by your plan, which is a required component ofall contracts submitted for review (it can be found in Section A, #3 of the DOH 4255,it is also typically in the footer of your contract documents. *You must populateeither field 25 or 26, preferably both fields should be populated. |
| 27 | Prov_Att_start_date | This is the attribution start date with the provider, when the member was first attributed to 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. |
| 28 | Prov_Att_end_date | This is the attribution end date with the provider, when the member was last attributed to 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. |
SUBMISSION EXAMPLES:
Please refer to Appendix IV, Table 6 at the end of this manual, for layout examples of both TXT and CSV files.
FILE SUBMISSION:
Files for all arrangement types 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 (bxb22).
Files are to be submitted by close of business on Monday, August 3, 2020.
MLTC ATTRIBUTION FILE
For 2020, all P4P Category 1 measures for the MLTC arrangement will be computed by DOH to reduce the burden on the MTLC plans.
ATTRIBUTION METHODOLOGY:
Partial/MAP/PACE/FIDA: Plan enrollees who have four or more months of continuous enrollment from April 2019 through June 2020 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 quality measures. Services being received by the member through Consumer Directed Personal Assistance (CDPAS) should not be included in this attribution file.
FILE FORMAT:
- Include only members who had 4 months or more continuous enrollment in an MLTC plan from April 2019 through June 2020.
- For each member from step 1, list all provider organization(s) that provided at least one service per month, for 4 or more continuous months from April 2019 through June 2020. The data should be formatted in a long form containing one row of data for each member/provider combination. Please provide at least one row of data for every provider a member was serviced by (see Example 1 and 2 below). If a member does not have any providers from which they received 4 or more continuous months of care, THE MEMBER SHOULD NOT BE LISTED. This is a change from last year´s specifications.
- 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.
- Fixed-width files
- The following table provides instructions on the submission of member-level data.
| # | Field Name | Data Type | Length | Start Column | End Column | Details/Comments |
|---|---|---|---|---|---|---|
| 1 | CIN | Varchar | 8 | 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 | 8 | 9 | 16 | The MLTC Plan´s numeric eight-digit ID. This field may not be NULL. |
| 3 | Prov_NPI | Varchar | 10 | 17 | 26 | The unique 10-digit National Provider Identifier (NPI) for the provider the member was serviced by during the reporting period. |
| 4 | Prov_start_ date | Date | 8 | 27 | 34 | MMDDYYYY - Must be between April 2019 - June 2020 |
| 5 | Prov_end_date | Date | 8 | 35 | 42 | MMDDYYYY - Must be between April 2019 - June 2020 |
| 6 | Contractor_TIN | Varchar | 9 | 43 | 51 | The unique 9-digit tax identification number of the VBP Contractor. Only submit the TIN, if this member is included in a level 2 or higher arrangement with a VBP Contractor. If not applicable or level 1 arrangement, fill with 999999999. |
| 7 | Contractor_Type | Varchar | 1 | 52 | 52 | 1= CHHA, LHCSA, 2= IPA, 3= Hospital, 4= ACO, 8= Other, and 9= NA. Only submit if this member is included in a level 2 or higher arrangement with a VBP Contractor. If not applicable or level 1 arrangement, fill 9 = NA. |
| 8 * | DOH_VBP_ Contract_# | Number | 4 | 53 | 56 | The number provided by DOH in the Agreement approval letter, begins with DOH ID ###. You must populate either field 8 or 9, preferably both fields should be populated. |
| 9 * | MCO_Unique_ Contract_ID# | Varchar | 50 | 57 | 107 | Plan generated ID used to submit contract to DOH; Section A, #3 of the 4255. You must populate either field 8 or 9, preferably both. |
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.
Contractor TIN: This is the unique 9-digit tax identification number of the VBP Contractor (not the provider) that the member is assigned to for a Level 2 arrangement during the reporting period. A member can only be assigned to one level 2 or higher VBP contactor at a time. If not applicable or level 1, fill with 999999999.
Contractor_Type: The VBP Contractor may be an ACO, IPA, hospital, or large LHCSA/CHHA that is coordinating services for many LHCSAs or CHHAs. This field is for the VBP Contractor (not the provider) that the member is assigned to a level 2 or higher arrangement during the reporting period. A member can only be assigned to one level 2 or higher VBP contactor at a time. If not applicable or level 1 arrangement, fill with 9.
*DOH_VBP_Contract_#: This is the number provided by DOH in the Agreement approval letter for your VBP arrangement, it begins with DOH ID ####.
*MCO_Unique_Contract_ID#: This is the contract identifier created by your plan, which is a required component of all contracts submitted for review (it can be found in Section A, #3 of the DOH 4255, it is also typically in the footer of your contract documents.
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 OQPS MLTC Evaluation mailbox. Files are to be submitted by close of business on August 3, 2020.
NOTE: When a Provider/NPI has overlapping service dates for a member, the service dates should be collapsed into one record with the earliest start date and furthest end date. Multiple rows for the same member/provider may be provided only if the provider/NPI has nonoverlapping service dates and each time frame meets the 4 months of service criterion. (see Example 3 below).
SUBMISSION EXAMPLES:
Example 1 and 2 below illustrates two different providers, with overlapping services dates, aiding a single member from February through June 2020.
Example 3 below illustrates a member who was continuously enrolled for 4 or more months in the health plan and received at least one service per month from same provider organization for 4 or more continuous months, for two separate non-overlapping time periods and is covered by level 2 or higher VBP contract during April 2019 through June 2020.
FULLY CAPITATED PLANS:
Because the HEDIS and CMS based P4R category 1 measures cannot be calculated by the State, plans must calculate and report Plan/Provider-VBP Contractor performance to the State by June 17, 2020. 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 OQPS MLTC Evaluation mailbox.
Plans should submit an Excel file with the following format. Submit a row for each measure being reported. Plans are required to report on all measures for each plan-provider combination.
| # | Field Name * | Data Type | Excel Column Placement | Details/Comments |
|---|---|---|---|---|
| 1 | MMIS_ID | Varchar | Column A | The MLTC Plan´s numeric eight-digit ID. This field may not be NULL. |
| 2 | Prov_NPI | Varchar | Column B | The unique 10-digit National Provider Identifier (NPI) for the provider the member was serviced by during the reporting period. This field may not be NULL. |
| 3 | Measure ID | Varchar | Column C | Use the measure ID from table below |
| 4 | Denominator for Measure | Varchar | Column D | Report the total number of members included in the denominator for the given measure |
| 5 | Numerator for Measure | Varchar | Column E | Report the total number of members that were included in the numerator for the given measure |
| 6 | Exclusions for Measure | Varchar | Column F | Report the number of members excluded from the given measure |
| 7 | Rate for Measure | Varchar | Column G | Report the rate to the hundredth decimal place |
| 8 | Contractor_TIN | Varchar | Column H | The unique 9-digit tax identification number of the VBP Contractor. Only submit the TIN, if this member is included in a level 2 or higher arrangement with a VBP Contractor. If not applicable or level 1 arrangement, fill with 999999999. |
| 9 | Contractor_Type | Varchar | Column I | 1= CHHA, LHCSA, 2= IPA, 3= Hospital, 4= ACO, 8= Other, and 9= NA. Only submit if this member is included in a level 2 or higher arrangement with a VBP Contractor. If not applicable or level 1 arrangement, fill 9 = NA. |
| 10 * | DOH_VBP_ Contract_# | Varchar | Column J | Number provided by DOH in Agreement approval letter, begins with DOH ID ####. *You must populate either field 10 or 11, preferably both. |
| 11 * | MCO_Unique_ Contract_ID# | Varchar | Column K | Plan generated ID used to submit contract to DOH; Section A, #3 of the 4255. *You must populate either field 10 or 11, preferably both. |
| * See Field Definitions under preceding MLTC Attribution File specifications | ||||
| Measure Name | Measure ID |
|---|---|
| MAP and FIDA P4R measures (Measure Source/ Steward: NCQA/ HEDIS) | |
| Antidepressant Medication Management - Effective Acute Phase Treatment * | 1 |
| Antidepressant Medication Management - Effective Continuation Phase Treatment* | 2 |
| Colorectal Cancer Screening * | 3 |
| Comprehensive Diabetes Care: Eye Exam (Retinal) Performed* | 4 |
| Comprehensive Diabetes Care: Medical Attention for Nephropathy | 5 |
| Follow-up After Hospitalization for Mental Illness - 7 Days^ | 6 |
| Follow-up After Hospitalization for Mental Illness - 30 Days^ | 7 |
| Initiation of Alcohol and Other Drug Dependence Treatment * | 8 |
| Engagement of Alcohol and Other Drug Dependence Treatment * | 9 |
| PACE P4R measures (Measure Source/ Steward: CMS) | |
| PACE Participant Emergency Department Utilization Without Hospitalization | 10 |
| Percentage of Participants Not in Nursing Homes | 11 |
| Percentage of Participants with an Annual Review of Their Advance Directive or Surrogate Decision-Maker | 12 |
| * Included in the IPC/TCGP measure set ^ Included in the Health and Recovery Plan (HARP) measure set |
|
IV. APPENDIX
TABLE 3: 2019 VBP LIST OF CATEGORY 2 MEASURES
| Measures | Notes | Arrangement Type | NQF ID | Measure Steward | ||||
|---|---|---|---|---|---|---|---|---|
| TCGP | IPC | Maternity | HARP | HIV/AIDS | ||||
| Integrated Primary Care (IPC)/ Total Care for the General Population (TCGP) | ||||||||
| Asthma Action Plan | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | AAAAI | ||
| Asthma: Assessment of Asthma Control - Ambulatory Care Setting* | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | AAAAI | ||
| Asthma: Lung Function/Spirometry Evaluation | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | AAAAI | ||
| Depression Remission or Response for Adolescents and Adults* | Cat 2 | Cat 2 | NA | NA | Cat 2 | HEDIS 2019 | ||
| Depression Remission or Response for Adolescents and Adults* | Cat 2 | Cat 2 | NA | NA | Cat 2 | HEDIS 2019 | ||
| Developmental Screening Using Standardized Tool, First Three Years of Life | Cat 2 | Cat 2 | NA | NA | NA | 1488 | Oregon Health and Science University | |
| Follow-up after Emergency Department Visit For Alcohol and Other Drug Dependence | Cat 2 | Cat 2 | NA | NA | NA | HEDIS 2019 | ||
| Follow-up after Emergency Department Visit For Mental Illness | Cat 2 | Cat 2 | NA | NA | NA | 2605 | HEDIS 2019 | |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (asthma) | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | 338 | The Joint Commission | |
| Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | NYS 2019 | ||
| Maternal Depression Screening | Cat 2 | Cat 2 | NA | NA | NA | 1401 | HEDIS 2019 | |
| Screening for Reduced Visual Acuity and Referral in Children | Cat 2 | Cat 2 | NA | NA | NA | 2721 | CMS | |
| 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 First-Line Psychosocial Care for Children and Adolescents on Antipsychotics | Cat 2 | Cat 2 | NA | NA | NA | 2801 | HEDIS 2019 | |
| Use of Pharmacotherapy for Alcohol Use Disorder | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | NYS 2019 | ||
| Use of Pharmacotherapy for Opioid Dependence | Cat 2 | Cat 2 | NA | Cat 2 | Cat 2 | NYS 2019 | ||
| Maternity | ||||||||
| Antenatal Hydroxyprogesterone | NA | NA | Cat 2 | NA | NA | TBD | ||
| Antenatal Steroids | NA | NA | Cat 2 | NA | NA | 476 | TJC | |
| Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery | NA | NA | Cat 2 | NA | NA | 473 | 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 Hospital or Birthing Facility Discharge | NA | NA | Cat 2 | NA | NA | 475 | Centers for Disease Control and Prevention | |
| Intrapartum Antibiotic Prophylaxis for Group B Streptococcus (GBS) | NA | NA | Cat 2 | NA | NA | 1746 | Massachusetts General Hospital | |
| Postpartum Blood Pressure Monitoring | NA | NA | Cat 2 | NA | NA | TBD | ||
| Vaginal Birth After Cesarean (VBAC) Delivery Rate, Uncomplicated | NA | NA | Cat 2 | NA | NA | NYS 2019 | ||
| Health and Recovery Program (HARP) | ||||||||
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder | NA | NA | NA | Cat 2 | NA | 1880 | CMS | |
| Mental Health Engagement in Care - 30 Days | NA | NA | NA | Cat 2 | NA | NYS 2019 | ||
| Percentage of HARP Enrolled Members Who Received Personalized Recovery Oriented Services (PROS) or Home and Community Based Services (HCBS) | NA | NA | NA | Cat 2 | NA | NYS 2019 | ||
| 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 | ||
| Linkage to HIV Medical Care | NA | NA | NA | NA | Cat 2 | NYS 2019 | ||
| Medical Case Management: Care Plan | 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 | ||
| Substance Abuse Screening | NA | NA | NA | NA | Cat 2 | HRSA | ||
TABLE 4. 2020 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 |
| Percentage of long stay residents who self-report moderate to severe pain | 1, 2 | Cat 2 | MDS 3.0 + /CMS |
- Included in the NYS DOH Nursing Home Quality Initiative measure set
- MDS 3.0 denotes the Centers for Medicare and Medicaid Services Minimum Data Set for nursing home members
- Included in the NYS DOH MLTC Quality Incentive measure set
TABLE 5 - NYS FIPS CODES BY COUNTY
| County Name | FIPS Code | County Name | FIPS Code | County Name | FIPS Code |
|---|---|---|---|---|---|
| Albany | 001 | Jefferson | 045 | Schenectady | 093 |
| Allegany | 003 | Kings | 047 | Saratoga | 091 |
| Bronx | 005 | Lewis | 049 | Schoharie | 095 |
| Broome | 007 | Livingston | 051 | Schuyler | 097 |
| Cattaraugus | 009 | Madison | 053 | Seneca | 099 |
| Cayuga | 011 | Monroe | 055 | St. Lawrence | 089 |
| Chautauqua | 013 | Montgomery | 057 | Steuben | 101 |
| Chemung | 015 | Nassau | 059 | Suffolk | 103 |
| Chenango | 017 | New York | 061 | Sullivan | 105 |
| Clinton | 019 | Niagara | 063 | Tioga | 107 |
| Columbia | 021 | Oneida | 065 | Tompkins | 109 |
| Cortland | 023 | Onondaga | 067 | Ulster | 111 |
| Delaware | 025 | Ontario | 069 | Warren | 113 |
| Dutchess | 027 | Orange | 071 | Washington | 115 |
| Erie | 029 | Oswego | 075 | Wayne | 117 |
| Essex | 031 | Orleans | 073 | Westchester | 119 |
| Franklin | 033 | Otsego | 077 | Wyoming | 121 |
| Fulton | 035 | Putnam | 079 | Yates | 123 |
| Genesee | 037 | Queens | 081 | Out of State | 000 |
| Greene | 039 | Rensselaer | 083 | Unknown/Missing | 999 |
| Hamilton | 041 | Rockland | 087 | ||
| Herkimer | 043 | Richmond | 085 |
TABLE 6: SUBMISSION EXAMPLES
The example below illustrates one member attributed to two different providers, in the same VBP arrangement, within the reporting period submitted as a fixed-width TXT file.
Member Data, attributed to Provider 1 from 1/1/2019 to 04/30/2019
Member Data, attributed to Provider 2 from 5/1/2019 to 12/31/2019
The example below illustrates one member´s data submitted as a CSV file.
Fields 1-9:
| Plan ID# | Product Line | Member ID (CIN) | FIPS Code | Zip Code | Practice Tax ID (TIN) | PCMH Site ID | Practice Site ID | Practice Name |
|---|---|---|---|---|---|---|---|---|
| 123456 | 01 | WA12345X | 123 | 12110 | 123456789 | ABC001234-5 | ABC1234567-89 | ABC Health Clinic West |
Fields 10-16:
| Practice Address Line 1 | Practice Address Line 2 | Practice Address Line 3 | Practice Address City | Practice Address State | Practice Address Zip Code | Practice Telephone Number |
|---|---|---|---|---|---|---|
| 123 Health Highway | Medical Arts Building | Suite 632 | Your Town | NY | 12345 | 5189634582 |
Fields 17-24:
| Provider NPI | Provider First Name | Provider Middle Initial | Provider Last Name | VBP Contractor Tax ID# | VBP Contractor DBA Name | VBP Contractor Type |
|---|---|---|---|---|---|---|
| N987654321 | Addison | M | Johnson-Williams | 123456789 | Health Clinic NY | 1 |
Fields 25-286:
| VBP Arrangement Type | DOH VBP Contract ID | MCO Unique Contract ID# | Provider Attribution Start Date | Provider Attribution End Date |
|---|---|---|---|---|
| 1 | 0983 | ABC.HealthClinic4.12.18 | 01/01/2019 | 12/31/2019n |
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