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OMPP Update on Value Based Purchasing (VBP) calculation and State Plan Amendment (SPA)

Posted Nov 27, 20191 min Read

Payment & Reimbursement

Several weeks ago, OMPP announced that due to CMS’ immediate elimination of the quality measure for “percentage of long-stay residents who report moderate to severe pain,” it was in the process of working on options for our VBP calculation. This week, OMPP clarified the following:

  1. July 1, 2019 rates will include the pain measure in the Quality Measures component.
  2. For July 1, 2020 rates, the pain measure will not be included in the VBP calculation because this data will not be published by CMS.  Instead, OMPP will use the process described below in the submitted SPA language:

For facilities that are missing a score for a quality measure, gross up the total score of its remaining quality measures. The total score from the remaining quality measures is then multiplied by the product of nine (9) divided by the number of its quality measures with a score. The resulting value is then rounded to the nearest twenty (20) point increment. 

  1. For July 2021 rates, OMPP will establish a stakeholder group to re-evaluate the VBP program to align with Medicare measures and officially remove the pain measure.   OMPP also noted that SPA approval is imminent because it has moved to the final set of CMS reviewers.