DOH Releases 2014 NH Quality Pool Methodology

The Department of Health (DOH) has released a Dear Administrator Letter and methodology summary for the 2014 Nursing Home Quality Initiative (NHQI). Among the changes being made are a revision to the point distributions, a new improvement standard and revisions to certain of the measures. Meanwhile, the State is still awaiting action from the Centers for Medicare & Medicaid Services (CMS) on the 2013 NHQI payments. 

The overall point distributions in the NHQI are being revised to increase the total points in the quality component from 60 to 70 and correspondingly decrease the weight given to Potentially Avoidable Hospitalizations (PAH) from 20 to 10 points. Each of the 14 quality measures will now be worth five points. A new improvement standard is being introduced to reflect changes from the 2013 NHQI results. The three Quality Measures (QMs) for vaccinations are being revised, with the resident flu and pneumococcal vaccine QMs now based on more restrictive measures of actually receiving the vaccinations, and the employee flu vaccine measure based on an 85 percent threshold. The PAH measure is being revised to reflect the primary diagnosis in the hospital discharge record rather than the previously-used admitting diagnosis. Finally, as advocated by LeadingAge NY, an adjustment will be applied to the Five-Star survey rating to reflect regional variations in survey results. 

As previously noted, LeadingAge NY advocacy also led to a legislative change in the 2014-15 State budget eliminating the facility exclusion from receiving NHQI funding based on a determination of fraud and abuse by the Attorney General due to findings made against individual workers in the facility. 

DOH is still awaiting approval from CMS of the Medicaid State Plan Amendment (SPA) authorizing payments under the 2013 NHQI. The SPA for the 2014 NHQI was filed on June 30, 2014 and is also pending. Facilities are reminded that the 2013 cost report must be completed, filed and certified by Aug. 15 (for calendar year filers) and by Sept. 30 (for fiscal year filers) to be eligible for five NHQI points under compliance and another five points for the QM for annual level of temporary contract/agency staff used.     

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