FAQ Directory: Long-Term Services and Supports Distinction for Health Plans

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4.15.2019 Value-Based Payment Requirement for PHM 3, Element B If a value-based payment program is new, there may not be payments for all months of the look-back period. How can the program be documented to meet the requirement, and how should this be reflected in the workbook?

The organization does not need to have value-based payments for every month of the look-back period. It reports:

As the numerator: The value-based payments made during the look-back period, and
As the denominator: All payments (including fee-for-service) made during the entire look-back period.

For example, the denominator is 12 months of all payments, but if there are 3 months of value-based payments in the look-back period, the numerator is the 3 months of value-based payments.

HP 2019