Recent Developments on Nursing Home “Quality Pool”

LeadingAge NY and the Continuing Care Leadership Coalition recently wrote a joint letter to State Health Commissioner Howard Zucker urging the Department of Health (DOH) to take the necessary steps to implement Nursing Home Quality Initiative (NHQI) payment adjustments, which are pending for 2013-15. We are pleased to report that DOH officials have advised that the State plans to publish regulations for the NHQI program in the very near future.

The Centers for Medicare & Medicaid Services (CMS) had previously granted approvals to the State for the 2013 and 2014 NHQI payment adjustments. DOH had completed the calculations and obtained Division of the Budget approval for the 2013 quality pool adjustments, and was in the process of finalizing the calculations for 2014. 

However, on June 9, 2015, a group of nursing homes filed litigation in New York State Supreme Court, Queens County [Dry Harbor Nursing Home et al v. Zucker et al] challenging the implementation of the NHQI. The Dry Harbor plaintiffs alleged certain procedural, constitutional, and substantive issues, including, perhaps most notably, the absence of published and promulgated regulations authorizing the program. The Dry Harbor case was originally filed in Queens, but earlier this year Howard G. Lane, J.S.C. Queens County, agreed to the State’s request to change venue to Albany County. We understand that oral arguments in the lawsuit are slated to occur in the near future in Albany County State Supreme Court.

State plan amendments for the 2015 and 2016 NHQI adjustments have been filed with CMS for review and are currently pending. LeadingAge NY will keep members posted on the status of the NHQI program.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383 ext. 128