Value Based Payment Reform in New York State: A Proposal to align Medicare’s and NYS Medicaid’s Reforms

Introduction Both the Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) have embarked on an ambitious journey to improve outcomes for patients and populations, reward the delivery of high value care by providers, and increase long‐term financial sustainability. In this document, New York State presents an approach to maximally align CMS’ payment reform efforts for Medicare to the NYS’ Medicaid Payment Reform Roadmap which has recently been approved by CMS. NYS proposes to allow its providers and Managed Care Organizations to voluntarily include Medicaid services and beneficiaries in CMS innovative payment models (ACOs, Integrated Primary Care models, Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement Model (CCJR)). In parallel, NYS requests CMS to allow NYS Medicare‐certified providers to voluntarily include Medicare FFS services and patients in the VBP Arrangements outlined in the NYS Payment Reform Roadmap.