DOH Posts 2016 NH Quality Pool Methodology
The Department of Health (DOH) has released the methodology for the 2016 Nursing Home Quality Initiative (NHQI), which reflects one change from the 2015 version – it incorporates a staffing hours measure based on Medicaid cost report data. DOH also intends to create a new “Honor Roll” to recognize nursing homes that attained the top quintile across the first three years of the NHQI. Meanwhile, the payment adjustments for the 2013-15 NHQI results are still on hold.
DOH’s Dear Administrator Letter and 2016 methodology document detail the new methodology, which includes the one change being made. Specifically, the CMS 5-star staffing hours measure (which is based on a two-week snapshot) is being replaced by an annualized staffing hours measure taken from Medicaid cost reports and adjusted for case-mix and predicted staffing hours using the MDS. The new annualized staffing hours measure was reported to facilities in the 2015 results for benchmarking purposes only, but was not used in the scoring of the 2015 NHQI. Like other quality measures, this staffing measure is worth five points out of the total possible 100 points in the NHQI overall rating, and will be scored and rated on a quintile basis.
Another staffing measure that was reported to facilities for information only in 2015 was the percent of staff turnover, based on cost report data. However, due to questions about the validity of the source data and the results, this measure is not proposed for inclusion in the 2016 NHQI scoring. DOH is asking facilities to pay special attention to Schedules P and O of the 2015 Medicaid cost report to ensure they reflect the correct types of staff, for purposes of measuring staff turnover.
Facilities are reminded that the 2015 cost report must be completed, filed and certified by July 15, 2016 for calendar year filers and Oct. 31, 2016 for fiscal year filers to be eligible for five NHQI points under compliance and ten additional points under the quality measures. Each member facility should verify well before the due date that any individual(s) who would be responsible for certifying the cost report have active Health Commerce System accounts.
DOH will soon be posting on its NHQI web page (http://www.health.ny.gov/health_care/medicaid/redesign/nursing_home_quality_initiative.htm) the new “Honor Roll” to recognize nursing homes that attained the top quintile in the NHQI across a rolling three-year period. The first posting will reflect 2013-15 results.
Concerns remain about the protracted delays in making the NHQI payment adjustments, which have yet to be made for 2013-15. DOH has indicated that unresolved litigation challenging implementation of the NHQI has delayed the payments, which the federal government had already approved for 2013 and 2014. More recently, DOH has said that it has filed a motion with the NYS Supreme Court, Albany County, to have the case dismissed.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866