Good news: Following VHCA-VCAL’s discussions with the agency, DMAS will restart the payment process for the Medicaid Value Based Purchasing (VBP) Program for three of the metrics immediately (UTI, pressure ulcer, RN staffing).

• DMAS has asked the managed care organizations to expediate payment to providers for the three metrics (i.e., not take the entire 30 days).

• DMAS has stated that these amounts should not have changed but they are in the process of verifying that.
• The staffing ratio metric will be paid “at a later date” in order to allow further validation of the corrected results.

Staffing ratio metric update: DMAS completed the preliminary recalculation of the correct ratio from the PBJ quarterly reports and is in the process of further validating the results and will be providing the data for analysis by VHCA-VCAL as soon as possible.

• DMAS verified that not only did it use the wrong ratio from PBJ in the performance calculations, but the wrong ratio was used in the base year calculations as well.
• However, DMAS has affirmatively stated that the attainment thresholds for this metric will not change for both this year (SFY23) and next year (SFY24);

• In SFY 2025, we will likely see a re-setting of the thresholds using the correct ratio. That process is to be determined. We will keep you updated as we learn more.

Determining your expected payment: If you requested VBP results from VHCA-VCAL, the UTI, pressure ulcer, and RN staffing metrics should be accurate and together represent the payment total you should receive in the weeks after April 10^th, depending on how quickly the MCOs can process the payments, according to the revised schedule. 

• You should ignore the results previously provided by VHCA-VCAL for the first metric, “Weighted Case Mix Hours”, as this will be recalculated. We will communicate the corrected results and payment timing of the “Weighted Case Mix Hours” once DMAS validates the results and starts the payment process for that metric.

Please be advised that our internal analysis showed some considerable swings in payment amounts for the staffing ratio metric using the corrected data against the existing attainment thresholds. We were not yet aware of the baseline data issue, which will have an impact on the “improvement” side of the equation as well.

• In other words, the previously reported payments for this metric may be way off on an individual facility basis.

Questions: Please ask any questions now. We will answer them to the best of our ability or work to get you answers.

• We may not have answers until we have had further conversations with DMAS and an opportunity to review the data ourselves.