Supplemental Quality Incentive Payments

In SFY 2022, the Georgia Legislators with support from Governor Brian Kemp appropriated $115 million dollars for a nursing home supplemental quality incentive payment.

The Centers for Medicare and Medicaid Services has acceptance Georgia State Plan Amendment (SPA) GA 21-0009. The SPA allows DCH to pay a supplemental quality incentive payment to skilled nursing facilities that meet one of the following four quality metrics set by DCH.

Quality Metrics

  • Percentage of high risk long-stay residents with pressure ulcers
  • Percentage of long-stay residents who received an antianxiety or hypnotic medication
  • Percentage of long-stay residents who received an antipsychotic medication
  • Percentage of long-stay residents with a urinary tract infection
  • DCH will release the first supplemental quality incentive payment to Nursing Facilities on the June 2, 2022 via MMIS remittance

DCH released the first supplemental quality incentive payment to Nursing Facilities on the June 2, 2022 via MMIS remittance.

The Department revised the nursing home Quality Incentive Supplemental Payment file to include nursing homes not previous included in the original file.  The CMS decile per nursing did not change, however the reallocation of state appropriated funds resulted in increases and/or decreases in the amount of supplemental payments for some nursing homes.

For additional information regarding the long-stay resident quality metrics, see the Frequently Asked Questions below.

  • What is the Georgia Supplemental Quality Incentive Payment Program?

    Georgia will provide a supplemental quality incentive payment to skilled nursing facilities that demonstrate improvement in certain quality metrics that measure the quality of care rendered to its Medicaid beneficiaries.

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  • Are all Nursing Facilities included in the Measures of the Quality of Resident Care in Nursing Homes report?

    No. Only Georgia certified Medicaid Nursing Facilities are included in this report.

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  • Should all Nursing Facilities in the Measures of the Quality of Resident Care in Nursing Homes report receive an incentive payment?

    No. Only Nursing Facilities which demonstrated improvement in one or more of the specific quality metrics will receive the incentive payment.

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  • What data is used to evaluate Nursing Facilities performance?

    The MDS Quality Measures, reported by the Nursing Facilities and released by CMS, was the source data used to evaluate nursing facilities’ performance.

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  • Where can I find the data used to evaluate performance?

    The Nursing Facility’s MDS Quality Measure used to evaluate nursing facilities’ performance can be found on CMS.gov.

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  • Which quality measures are used in the payment model?

    Each Nursing Facility’s performance was evaluated using the following four (4) long-stay resident quality measures:

    • Percentage of high risk long-stay residents with pressure ulcers
    • Percentage of long-stay residents who received an antianxiety or hypnotic medication
    • Percentage of long-stay residents who received an antipsychotic medication
    • Percentage of long-stay residents with a urinary tract infection.
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  • What period of data is used in the payment model?

    The 4-quarter average score comparing one calendar year of data to the previous calendar year of data (e.g., 2020Q1 – 2020Q4 and 2021Q1 – 2021Q4). For each subsequent year after calendar year 2020, the base year will be adjusted annually to reflect improvement against the prior year. For example, CY2021 would be paid out for improvement for CY2020, CY2022 would be paid out for CY2021, and CY2023 against improvement in CY2022. Only those facilities which demonstrate improvement will be eligible for the add-on payment.

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  • How do you use the data to evaluate the performance?

    Each Nursing Facility’s 4-quarter average scores are compared for improvement. If the percentage for each measure decreases, which indicates improvement, the Nursing Facility is marked as an improved facility.

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  • How often will the Department of Community Health make supplemental quality incentive payments to Nursing Facilities?

    Supplemental payments will be distributed to eligible nursing facilities twice per year. However, in year one (SFY2022), eligible nursing facilities will only receive one payment.

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  • How does DCH distribute the payment to each improved Nursing Facility?

    For a specific quality measure, the improved facilities are ranked based upon the largest increase of improvement. Deciles are assigned based on the Nursing Facility’s ranking. Each Nursing Facility within the same decile will receive the same payment based on a weighted distribution of available funds.

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