powered by LeadingAge New York

DOH Processes 2 Percent Quality Penalty

The Department of Health (DOH) has processed the most recent 2 percent penalty for nursing homes with the lowest Nursing Home Quality Initiative (NHQI) scores. The adjustment to 2021 Medicaid fee-for-service rates retroactive to Jan. 1, 2021 was reflected in payment cycle 2310, with a check release date of Dec. 15th. Homes subject to the adjustment will find associated January and July 2021 rate sheets on the Healthcare Financial Data Gateway section of the Health Commerce System (HCS). The accompanying Dear Administrator Letter (DAL) is available here.

Homes that are in the lowest quintile in the most recently released NHQI year (2020 payment year) and that were also in the lowest or second-lowest quintile in the prior year (2019 payment year) are subject to the penalty, with hardly any LeadingAge NY members on the penalty list. The negative adjustment was incorporated into the managed care benchmark rate list earlier in the year. We congratulate member nursing homes for maintaining high quality in this challenging environment.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-461-5993