State Revises Quality Pool Proposal

DOH has revised its nursing home quality pool proposal, and plans to issue reports by May showing baseline 2011/12 values for each facility. Several LeadingAge New York recommendations have been adopted, but concerns remain over risk adjustments of measures and the source of funds, among other issues.

The 2013 quality pool would score and compare facilities’ performance in the following categories: (1) Up to 13 quality measures based on MDS 3.0, vaccination and staffing data (60 points); (2) Compliance measures based on the CMS Five-Star health inspection rating and timely filing of Medicaid cost reports and immunization data (20 points); and (3) A measure of potentially avoidable hospitalizations for long stay residents (20 points).

In early fall 2013, DOH plans to calculate each facility’s quality pool score based on 2012 data. The scores would be ranked, with facilities in the top three quintiles (i.e., top 60 percent) receiving funding based on their scores and Medicaid revenues. Funding for the $50 million in quality payments will be accessed through a per diem quality pool adjustment to eligible nursing homes’ rates. LeadingAge NY will be commenting on the latest version this week, and welcomes member feedback.

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