LeadingAge NY Raises Issues on 2013 Quality Pool Results

With the assistance of members, LeadingAge New York has identified a few issues that could have an effect on eligibility and scoring results for the 2013 nursing home quality pool. We have raised concerns about the fraud/abuse exclusion, cost report submission and Quality Measure (QM) scores with DOH and are awaiting their response. We have also urged the Department to hold off on publicly releasing facility data until these issues are resolved.

Nursing homes are excluded from receiving quality pool funding, if they had a determination of fraud and abuse by the Attorney General in 2012-13. In cases brought to our attention by members, the findings were against individual workers in the facility, not the facilities themselves. We have asked DOH to reverse these exclusions when the facility was not the subject of the determination.

We have also been made aware of cases in which a facility submitted its cost report by the deadline, but encountered logistical problems in transmitting the operator certification by the due date. In these instances, the facility would lose not only the five points under compliance, but also 4.29 points for temporary contract/agency staff usage.  We have asked DOH to provide some flexibility on the compliance scoring in these cases, and to use available cost report data to assign a score for temporary contract/agency staff usage.

Finally, LeadingAge NY has been contacted by a few members that believe that there may be errors in their QM scores, and has asked to Department to review these cases. 

If your facility is affected by one or more of these issues or others, you should send an email to DOH’s Office of Quality and Patient Safety at NHQP@health.state.ny.us and be sure to copy us at LeadingAge NY. We will keep members posted on the status of these issues.  

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866