Nursing Facility Incentive Program

Purpose 

The Nursing Facility Incentive Program (NFIP) is a value-based purchasing quality improvement program for ND Nursing Facilities. The goal is to improve the overall outcomes of Nursing Facility residents through an annual incentive payment based on quality measure (QM) performance. 

Scope 

All Nursing Facilities that are Medicaid certified in North Dakota with Medicaid paid days and have been open for at least ten months of the respective Federal Fiscal Year.  

Specifics

The assessed QM are part of the Centers for Medicare & Medicaid Services (CMS) 5-star quality rating system and follow the 5-star QM Ranges for Point Values for Quality Measures thresholds identified in the Technical Users’ Guide. In addition to CMS QM, points will be assigned to active recipients of the AHCA/NCAL National Quality Award, which follows the National Institute of Standards and Technology's (NIST) Baldrige Performance Excellence Framework.  

Quality Measures 

• Long-stay urinary tract infections
• Long-stay antipsychotic use
• Long-stay pressure ulcers
• Long-stay hospitalizations 

An additional consideration will be given to active AHCA/NCAL National Quality Award (Baldrige Framework) recipients.

Points and Tiers 

Nursing Facilities will be assigned points for each QM and placed in four tiers based on the CMS FFY fourth quarter average performance data published in the Provider Data Catalog⁾ The total point range is 70-600. The point threshold for each tier are: Tier 1 is 400 points or more, Tier 2 is 300-399, Tier 3 is 200-299, and Tier 4 is less than 200. 

Incentive Payment 

The base QM Incentive Payment will be calculated using the legislature-allocated funds divided by the total number of eligible NF Medicaid days in the Federal Fiscal Year (FFY). The resulting dollar amount will be paid to each tier in graduated differences per Tier. Tier 1 will receive 100% of the base payment, Tier 2 will receive 85%, and Tier 3 60%. Tier 4 is not eligible for incentive funds.  

There will be an unspent balance since two of the tiers do not receive 100% of the base payment. That unspent money will be given to Tiers 1 and 2. The first 20% will be removed and allocated to Tier 1. The remaining balance will be shared between the two tiers. 

All monies will be distributed annually as an individual payment during the June quarter through MMIS. Allocations will not exceed the total allowable funding for the program. Nor will they exceed the allowable aggregate upper payment limit.