Quality Incentive/Vital Access Provider Pool

  • Update is also available in Portable Document Format (PDF)

Update

April 15, 2015

Agenda

  • Introduction
    • Mark Kissinger, Director, OHIP Division of Long Term Care, NYSDOH
    • John Ulberg, Director, OHIP Division of Finance and Rate Setting, NYSDOH
  • Review of QI/VAPP
    • Alene Hokenstad, Senior Director, IPRO
      • Background
      • Eligibility
  • Plan Attestation
    • Standards for Pool Eligibility
    • Documentation
  • Attestation Validation
    • Daniel Carmody, Manager, OHIP Division of Finance and Rate Setting, NYSDOH

Review of QI/VAPP

  1. What Is QI/VAPP?
    • Program focused on quality home and personal care services in MLTC
    • Rewards plans that invest in their network providers
    • Funds of 70 million dollars to be distributed to eligible plans, which will then distribute to their contracted qualified incentive pool providers (QIPP)
  2. How is a Plan eligible for QI/VAPP funds?
    • Plan is in compliance with wage parity statute
      (§ 3614–c, Home Care Worker Wage Parity)
    • Plan completes revised QI/VAPP Reconciliation excel spreadsheet, distributed March 26, 2015
    • Plan submits a QI/VAPP Reconciliation Attestation to DOH – Due May 1, 2015
      • Plans are required to make sure that both they and their contracted providers meet all of the requirements.
      • Documentation is required and will be subject to validation.
      • Failure to meet any of the eligibility requirements will disqualify the Plan from receiving QI/VAPP funds.

Plan Attestation to DOH

Due 5/1/2015– Pool Requirements

#1. Pay A Base Hourly Rate of $18.50

#2. Offer a Specialty Training Program that Exceeds the DOH Requirement

#3. Have a Written, Implemented and Currently Active Quality Assurance Program

#4. Provide Comprehensive Health Coverage Which Must Equal or Exceed the DOH Sample Qualified Incentive Pool Provider Benefit

Plan Attestation #1:

Pay a Base Hourly Rate

  • Pay a base contracted amount, defined as $18.50 per hour, that reflects the cost of investments for home and personal care aide services.
  • Those QI/VAPP eligible hours cannot be counted prior to April 1, 2014.
  • If rates were subsequently increased after April 1st but before September 1st, only hours paid at the qualifying level are eligible to determine QI/VAPP payment.

Plan Attestation #2:

Offer a Specialty Training Program

  • Maintain or participate in a specialty training program for home health aides and personal care aides.
  • Training programs must exceed DOH minimum training requirement and/or the in–service requirement which is:
  • Provide a letter of support for the training program from a labor organization. The Department will consider exceptions if a QIPP can demonstrate a specialty training program but cannot obtain a letter of support.
Home Health Aides
  • Basic: 75 hours
  • In–service: Twelve (12) hours per year.
Personal Care Aides
  • Basic: 40 Hours
  • In–service: Six (6) hours per year.

Plan Attestation #3:

Have a written Quality Assurance Program

  • A QIPP must have a written quality assurance program that has been successfully implemented and is currently active
    • Not a new requirement for LHCSAs –Section 766.9(k)
    • Includes internal review of policies and patient records
      • Must include Complaint Resolution Process
    • Written summary of review findings

Plan Attestation #4:

Provide Comprehensive Health Coverage

  • A QIPP must participate in a health benefit fund for their home health aides and/or personal care aides and/or provide comprehensive health insurance coverage to their employees.
  • The DOH Sample Qualified Incentive Pool Provider Health Benefit that must be provided is posted on the Department’s website.
Health Benefit Package Should Include:
Hospital Care
Hospice
Emergency Room Visits
Behavioral Health Services Inpatient/Outpatient
Maternity
Medical Services
Prescriptions
Vision
Dental
Hearing Aids

http://www.health.ny.gov/health_care/medicaid/redesign/2014–06–13–benefits_overview_qivapp_application_attach2.htm

Plan Documentation

Plan Documentation:

  • QI/VAPP Reconciliation spreadsheet
    • Eligible Hours for State Fiscal Year 2014–15
      • Actual hours from 4/1/14 – 2/28/15
      • Projected hours from 3/1/15 – 3/31/15
  • Attestation

Validation of Attestation

  • Plans should maintain a copy of the provider Wage Parity certification whether or not they have received QI/VAPP award
  • ALL supporting documentation for the Plan attestation is subject to validation
  • Plan submissions that cannot be validated upon review of supporting documentation will be referred to the Department for possible recoupment of QI/VAPP funds, and/or for OMIG referral

QI/VAPP Distribution

  • Total Pool value of $70 million
  • State share of $35M was released to plans based on information submitted by September 2, 2014.
  • Reconciliation of total pool value based on updated information including hours and attestation provided by May 1, 2015.
    • Information must be included for all providers
  • The total pool value of $70M will be reallocated based on updated hours received and CMS approval.

QI/VAPP Distribution Examples

Example – Pool Allocation to Plans

  A B C D E
Original Application Hours State Share Distribution Reconciled Hours Reconciled Distribution Final Plan Distribution (D – B)
Plan A 1,000,000 $10.0M 1,500,000 $23.9M $13.9M
Plan B 500,000 $5.0M 800,000 $12.7M $7.7M
Plan C 300,000 $3.0M 600,000 $9.5M $6.5M
Plan D 900,000 $9.0M 1,100,000 $17.5M $8.5M
Plan E 800,000 $8.0M 400,000 $6.4M ($1.6M)
Total 3,500,000 $35M 4,400,000 $70M $35M

Example – Plan Specific Allocation to Providers

Plan A A B C D E
Original Application Hours State Share Distribution Reconciled Hours Reconciled Distribution Final Plan Distribution (D – B)
Provider A 50,000 $0.5M 0 $0M ($0.5M)
Provider B 500,000 $5.0M 550,000 $8.8M $3.8M
Provider C 150,000 $1.5M 350,000 $5.6M $4.1M
Provider D 100,000 $1.0M 150,000 $2.4M $1.4M
Provider E 200,000 $2.0M 450,000 $7.2M $5.2M
Total 1,000,000 $10M 1,500,000 $24.0M $14.0M

For more information

Any questions concerning the reconciliation process should be directed to the Office of Health Insurance Programs, New York State Department of Health by e–mail at:

hcworkerparity@health.ny.gov

Information about QI/VAPP is available on the Department’s website:
http://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm