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DOH Processes Quality Pool Payment Adjustments

(June 18, 2024) The Department of Health (DOH) has processed the payment adjustments for the 2022 Nursing Home Quality Initiative (NHQI). The payment adjustments will be made in Medicaid payment cycle 2444, scheduled for release July 10th. The Dear Administrator Letter (DAL) is available here, and the facility-specific amounts along with backup calculations are here.

Because the NHQI is self-funded, it redistributes $50 million from those with lower overall NHQI scores to those with higher scores. Adjustments range from 1.2 percent of annual Medicaid revenue for those in the top quintile to a negative adjustment equaling 0.8 percent of annual Medicaid revenue for those in the bottom two quintiles.

As is the case with most lump-sum payments, any outstanding Medicaid liabilities will be offset against the positive adjustment. Those with negative adjustments will face a 15 percent recoupment starting with Medicaid cycle 2444. Please keep in mind that specialty facilities and Continuing Care Retirement Communities (CCRCs) do not participate in the NHQI.

Those working on future NHQI scores may want to review this Intelligence article on submitting employee influenza immunization data (due June 28th), since timely submission, along with the immunization rates themselves, are part of NHQI scoring.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841