NYS DOH Updates On PPS Progress And Provider Contract Guidelines For IPAs

NYS DOH Announces Provider Contract Guidelines For Article 44 MCOs, IPAs And ACOs

New York State Department of Health (DOH) released Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs with the intent of establishing standards for contract submission and review, clarifying required contract provisions, and effectuating the provisions of Article 44 of the Public Health Law and 10 NYCRR Part 98.

“These Guidelines are applicable only to contracts that allow for the arrangement, or provision of Health Care Services and Technical and Administrative Services incidental thereto. The Guidelines incorporate all provider reimbursement arrangements, including value based and traditional arrangements. Reference to the New York State Value Based Payment Roadmap (Roadmap) applies to Medicaid lines of business only. However, MCOs with commercial lines of business may use, in its own discretion, concepts from the Roadmap. Care management administrative service agreements and Health Home agreements do not come under the scope of these Guidelines.”


NYS DOH Releases PPS Progress Through DY3, Q1

NYS DOH’s recent reporting of the Performing Provider Systems (PPS) Progress indicates a substantial increased amount of funds flowed to network partners. As of June 2017, PPS have distributed 85% of all dollars earned ($878 million) to various categories of downstream partners.

“During the DSRIP Mid-Point assessment (MPA) process in February 2017, the DSRIP Project Approval and Oversight Panel (PAOP) encouraged PPS to increase their distribution of funds to network partners. As a result, PPS funds distributed to network partners increased by 112% or double the amount of cumulative distributions prior to the DSRIP mid-point.”

To be a recognized and valued network partner, building your value proposition is critical. It must address key strengths, opportunities, outcomes, risks and responsibilities. It must be versatile as well as specific in citing relevant impact on cost of care and alignment with population risk variables.