LeadingAge NY Comments on Nursing Home “Quality Pool” Regulations
In a Sept. 20th letter, LeadingAge NY offered general support for the Department of Health’s (DOH) proposed permanent regulations authorizing the Nursing Home Quality Pool (NHQP) for rate years 2013 onward. The NHQP has been operating under emergency regulatory authority, with the most recently adopted emergency regulation in effect through Oct. 13, 2017.
DOH had proposed permanent regulations authorizing the program in October 2016. The most recently proposed regulations modify the previously proposed regulations by making them more generic and less specific to the quality measures and other elements of the methodology that have changed since 2013. The regulatory notice refers to the NHQP Workgroup – on which LeadingAge NY is represented – which considers possible revisions to the methodology each year.
Our comments continue to urge DOH to identify an alternative funding source for the $50 million quality pool rather than making further across-the-board reductions to facilities’ Medicaid rates, and emphasize the need for timely payment of NHQP adjustments.
As members are aware, payment adjustments amounting to $50 million per year in total have not been made for the NHQP program. The federal Centers for Medicare & Medicaid Services (CMS) has approved the relevant Medicaid State Plan Amendments for 2013-17 for the program. However, a lawsuit filed in 2015 challenging the NHQP (Dry Harbor Nursing Home et al v. Zucker et al) was filed on behalf of a group of mostly upstate for-profit homes and has delayed the payment adjustments. The case is currently awaiting oral argument in New York State Supreme Court, Albany County.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866