Contract Payment Policy

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Note: The sections “Pay-for-Reporting Payments At Risk” and “Contract Payment Schedules” have been updated 03.10.2020 to reflect new Board decisions.

Pay-for-Reporting Model

In 2018 the BHT Board made several decisions regarding the allocation of Pay-for-Reporting Project dollars and categorization of Partners based on volume. You can read in detail about those decisions in the Funds Flow for 2019, 2020, & 2021 post.

The model states that Partners will be divided into three volume categories:

Large Providers: serving 20,001+ Medicaid Patients
Medium Providers: serving 1,201-20,000 Medicaid Patients
Small Providers: 1,200 or less Medicaid Patients

And also states that Pay-for-Reporting funds will be earned based on three categories of work.

40% Transformation Plan Milestones
40% Pay-for-Achievement Measures
20% Equity Activities & Milestones

In March of 2019 the Board made several more decisions that detail what activities will earn funds, a payment schedule, and minimum achievement. Those decisions are described below.

Earning Pay-for-Reporting Dollars

Over the next three years, a Partner’s earnings from each of the three categories of work and will be based on a combination of selecting measures, then reporting on and meeting those measures. Additionally, Partners will be earning funds based on completing specific activities required by BHT and the HCA.

As a reminder, Pay-for-Reporting and Pay-for-Performance are two different buckets of Project Funds.  Pay-for-Performance funds are earned by the region, for meeting the measures created by the Health Care Authority (HCA). These “at-risk” dollars will make up an increasing portion of our total Project Funds over the next three years.

Pay-for-Reporting Distribution by Partner

Between 2019 and 2021, approximately $17.6M of the total Pay-for-Reporting funds will be allocated to Collaboratives Partners. The table shows the potential Pay-for-Reporting earnings (per Partner), over the next three years:

Pay-for-Reporting Payments At-Risk - Year 1 Contracts

Partners will earn the majority of these Pay-for-Reporting funds based on timely and complete reporting. However, a portion of funding associated with both Transformation Plan Milestones and Pay-for-Achievement Measures will be “at risk” as the expectation for Partners to earn based on achievement increases (similar to the risk that the region has with the Pay-for-Performance funds described above). Meaning that to earn that portion, Partners must meet the Milestones specified in Addendum 3.01 of their Project Specific Agreement (“Contract”), and achieve the standards set for their selected Pay-for-Achievement Measures specified in Addendum 3.02.

In the event that a Partnering Provider meets some, but not all, of its Milestones and Pay-for-Achievement Measures, BHT will calculate partial payments on the “at-risk” portion. The at-risk payment tiers and criteria are as follows:

Pay-for-Reporting Payments At-Risk - Year 2 & Year 3 Contracts

Updated March 2020

For Year 2 and Year 3 contracts, providers must meet full payment criteria of 75%+ in order to earn their “at-risk” achievement-based contract payment.

  • Full Payment: 75%+ of milestones and Pay-for-Achievement measures achieved, including at least one milestone per project area (i.e. bi-directional, opioids, or chronic disease)

  • No payment: Less than 75% of milestones or Pay-for-Achievement measures achieved -or- 75%+ of Milestones/P4A overall but 1+ project area has no milestones met

See the Contract Performance Policy Amendment passed Oct. 2019 by the Board.

Contract Payment Schedules

Updated Dec 2021

Year 1 Contract start dates are April 1, 2019 for January Cohort and October 1, 2019 for August Cohort. Contracted Partners will earn funds from the above work categories, in three scheduled distributions. To view a Year 1 Contract payment breakdown by volume, including the amount at-risk, click on one of the following:

January Cohort - Large | Medium | Small
August Cohort - Medium | Small

Year 2 Contract start dates are July 1, 2020 for January Cohort and November 1, 2020 for August Cohort. Contracted Partners will earn funds from the above work categories, in three scheduled distributions. To view a Year 2 Contract payment breakdown by volume, including the amount at-risk, click on one of the following:

July 1 start date - Large | Medium | Small
Nov 1 start date - Large | Medium | Small

Year 3 Contract start dates are August 1, 2021 for January Cohort and December 1, 2021 for August Cohort. Contracted Partners will earn funds from the above work categories, in two scheduled distributions. To view a Year 3 Contract payment breakdown by volume, including the amount at-risk, click on one of the following:

Aug 1 start date - Large | Medium | Small
Dec 1 start date - Large | Medium | Small

Unearned “At-Risk” Pay-for-Reporting Funds

Any at-risk dollars not earned by Partners will be held in an unearned funds pool. The Board will decide how to use those dollars based on recommendations from our Waiver Finance Workgroup.

Update: See the Contract Performance Policy Amendment passed Oct. 2019 by the Board.