Nursing Home Quality Initiative Update

The Department of Health (DOH) is currently processing the Medicaid rate adjustments associated with the Nursing Home Quality Initiative (NHQI) – also known as the “Quality Pool” – for 2013 and is soon planning to release the preliminary facility results for the 2014 NHQI program.

DOH is targeting Nov. 30 as the date for sending to eMedNY for processing the schedule of NHQI adjustments to the 2013 Medicaid rates. Assuming this target date is achieved (there is no guarantee), payment adjustments would be made in cycle #1947 with a check release date of 12/31/14.

A total of $50 million will be distributed to eligible facilities whose overall scores ranked in the top three quintiles of performance. To fund the pool, all eligible facilities will have their rates reduced. The per diem amounts, by facility, are listed on DOH’s 2014 benchmark rates spreadsheet in the column marked “Quality Adjustment.” These figures represent the net amount of the adjustment for each facility, taking into account the funding of the pool and the award amounts. We understand that DOH  will be effecting this by reissuing the 2013 rates with the NHQI per diem adjustment amount reflected on the rate sheets. The annual amount of the adjustment will be calculated by multiplying the per diem adjustment shown on the list by Medicaid days billed for calendar year 2013, and applied as a lump sum adjustment to each facility's payment.   

DOH is also planning to release preliminary results of the 2014 NHQI by next week. These results will be shared with providers who will be asked to review them and share with DOH any issues or concerns with the calculations within two weeks. The Department is targeting early December for a broader public release of the 2014 NHQI results. A complete description of the final 2014 NHQI methodology is available here. DOH is still awaiting approval from the Centers for Medicare and Medicaid Services for payments associated with the 2014 NHQI. LeadingAge NY will keep members posted on further developments.

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