Nursing Home NHQI Take-Backs Hitting This Week
(May 6, 2025) Nursing homes with 2023 quality pool scores that fall into the fourth or fifth quintile should expect to see a reduction in this week’s Medicaid payment. The Department of Health (DOH) has processed payment adjustments related to the 2023 Nursing Home Quality Initiative (NHQI) and is implementing them across multiple Medicaid payment cycles. As noted in the updated Dear Administrator Letter (DAL), providers in the bottom two quintiles should start seeing associated negative payment adjustments in Medicaid cycle 2487, scheduled to be released on May 7th. While the payment adjustments may vary based on individual circumstances, most homes should expect a 15 percent recoupment from payment cycle 2487 as well as subsequent payment cycles until the outstanding liability is satisfied.
Members will recall that the NHQI is a self-funded quality pool, meaning that rather than additional resources being added, it redistributes $50 million in existing Medicaid funding from those with lower NHQI scores to those with higher scores. Note that the 2023 NHQI is primarily based on performance in 2022.
Providers whose 2023 NHQI score puts them in one of the top three quintiles should see a lump sum positive adjustment in payment cycle 2488, scheduled for release on May 14th. Those in the best quintile should see a positive adjustment of about 1.2 percent of annual Medicaid revenue, those in the second quintile will receive about 0.7 percent, while those in the third quintile will get approximately 0.2 percent. Facilities in the fourth and fifth quintiles will face a negative adjustment totaling approximately 0.74 percent of annual Medicaid revenue.
DOH has posted the backup calculations on the main DOH website here so that providers can see their adjustment amounts and verify that the Medicaid revenue figures that DOH is using are accurate. Please keep in mind that specialty facilities and units, as well as Continuing Care Retirement Communities, are excluded from the NHQI.
Separate and apart from the quality pool adjustment is the quality penalty that impacts homes that scored in the lowest quintile in the 2023 NHQI and were also in the fourth or fifth quintile in the 2022 NHQI. While this affects hardly any of our members, the penalty, a 2 percent reduction to annual Medicaid revenue, will be implemented at a later date.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841