New York Updates Quality Measures for Medicaid Managed Care Organizations in the Value Based Payment Program

February 2020 ~

The New York Department of Health released the 2020 value-based payment (VBP) Reporting Requirements Technical Specifications Manual for Measurement Year (MY) 2019. The report includes an overview of the specific quality measure reporting requirements for each VBP arrangement, as well as a description of the changes to the measure sets from 2018 to 2019.

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.

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.

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.
  • 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.

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. NOTE: 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.

For more information and full details on the revised measures, access the 2020 Value Based Payment Technical Specifications Manual here.

Source(s): HMA Weekly Roundup, February 19, 2020; 2020 Value Based Payment Reporting Requirements;

 

 

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