CMS Approves NH Quality Pool

Carl Pucci and Nancy Leveille in Finance & Reimbursement

Centers for Medicare & Medicaid Services (CMS) has just approved New York’s Medicaid State Plan Amendment (SPA), which authorizes payments related to the Nursing Home Quality Initiative (NHQI) for 2013. This plan amendment had been outstanding since March 2013. We will seek clarification from the Department of Health (DOH) on the timing of the associated Medicaid rate adjustments (retroactive to 1/1/13).

A total of $50 million will be re-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 rate spreadsheet http://www.health.ny.gov/facilities/long_term_care/reimbursement/nhr/benchmark/docs/jan_2014_rates_quality_07-2013_mds.pdf in the column marked “Quality Adjustment.” These figures represent the net amount of the adjustment for each facility, (i.e., combines both the funding of the pool with the awarded amounts.)

Please see NYSHFA member mailing for a complete description of the final 2013 NHQI methodology. Each nursing home’s score on individual NHQI measures is posted on DOH’s website https://health.data.ny.gov/Health/Nursing-Home-Quality-Initiative-Beginning-2012/aruj-fgbm.

The 2014 Quality Pool (with its own related SPA) is still pending with CMS.

NYSHFA CONTACT:

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20