3/2/2024 0 Comments Hedis well child visitsCategory 3: Rejected based on a lack of relevance, reliability, validity, and/or feasibility.Category 2: Seen as clinically relevant, valid, and reliable, but where the feasibility could be problematic.Ĭategory 2 measures are listed in the appendix (Table 3) of this guide.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 1: Selected as clinically relevant, reliable, valid, and feasible.Based on an analysis of clinical relevance, reliability, validity, and feasibility, each measure was placed into one of three categories: Through a multi-group stakeholder engagement process, a set of quality measures was defined for each arrangement. IPC arrangements: All references to Integrated Primary Care (IPC) arrangements and associated requirements have been removed from the VBP Roadmap 1.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.Behavioral Health/Health and Recovery Plans (HARP): for those with Serious Mental Illness or Substance Use Disorders.Children's Subpopulation: to address the unique needs of children at different developmental stages.Total Care for Special Needs Subpopulation Arrangements: Includes costs and outcomes of total care for all members within a subpopulation exclusive of TCGP.Total Care for the General Population (TCGP) Arrangement: Includes all costs and outcomes for care, excluding certain subpopulations (specified below).The VBP Roadmap updated in June 2022, outlines five types of VBP arrangements to be included for MY2022: VBP ARRANGEMENTS AND ASSOCIATED QUALITY MEASURES 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. ![]() With NYS PCMH, a Primary Care (PC) Core measure set was developed, and multi-payer data is used to calculate results for practices for the measure. The New York State Patient Centered Medical Home (NYS PCMH) model was created as part of the SIM initiative. The New York State Department of Health (NYS DOH) has completed 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. Sections V and VI provide guidance for Managed Long-Term Care (MLTC) VBP Arrangements. Sections II, III, and IV of this document include guidance for the organizations responsible for reporting, the subset of measures for which reporting will be required by Mainstream VBP Arrangements, and the changes to the reportable set of MY2022 Quality Measure Sets (see TABLE 1: 2022 VBP LIST OF REQUIRED MEASURES). The 2022-2023 VBP Reporting Requirements refer to data for Measurement Year 2022 (MY2022). 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 (NYS) Medicaid Value-Based Payment (VBP) program. MLTC VBP data files: All files must be received electronically by 11:59 p.m. Plan/Provider-VBP Contractor performance to the State by Friday, July 28, 2022 TABLE 8: MLTC ATTRIBUTION FILE - DATA QUALITY CHECKLISTĪll files must be received electronically by 11:59 p.m.TABLE 7: MCO ATTRIBUTION FILE - DATA QUALITY CHECKLIST.Member Data, attributed to Provider 2 from to.TABLE 4: 2023 VBP MLTC CATEGORY 2 MEASURES.TABLE 3: 2022 VBP LIST OF CATEGORY 2 MEASURES. ![]() TABLE 2: 2023 MLTC VBP LIST OF REQUIRED MEASURES.TABLE 1: 2022 VBP LIST OF REQUIRED MEASURES.IPC: Arrangement type removed from VBP Roadmap.MAINSTREAM & SUBPOPULATION VBP ARRANGEMENTS. ![]()
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