CMS Approves Nursing Home Quality Pool

The Centers for Medicare & Medicaid Services (CMS) has approved New York’s Medicaid State Plan Amendment (SPA 12-29), which authorizes payments related to the Nursing Home Quality Initiative (NHQI) for 2013. SPA 12-29 had been outstanding since March 2013. We are currently seeking further information from the Department of Health (DOH) on the timing of the associated Medicaid rate adjustments.  DOH had previously indicated that they would re-issue CY 2013 Medicaid fee-for-service rates with the NHQI per-day adjustment.

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 by a per diem amount. The estimated per diem amounts, by facility, are listed on DOH’s 2014 benchmark rates spreadsheet in the column marked “Quality Adjustment.” Even though listed along with the 2014 Medicaid rates, these figures represent the net amount of the 2013 adjustment for each facility, taking into account the funding of the pool and the award amounts.

A complete description of the final 2013 NHQI methodology is available here, and each nursing home’s score on individual NHQI measures is posted on DOH’s website. The LeadingAge NY NHQI tool that allows homes to compare their individual measure scores to regional averages can be accessed here.  A separate SPA filing for the 2014 NHQI program has been made and is still pending with CMS.

Contact:  Dan Heim, dheim@leadingageny.org or Darius Kirstein, dkirstein@leadingageny.org; 518-867-8383