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The Department of Human Services is developing a new program aimed at improving the quality of care and outcome for managed long-term services and support (MLTSS) members living in nursing homes. This program is a step in New Jersey’s evolving value based purchasing strategy with the goal to reimburse providers based on performance and to encourage consumers to select high value service providers.

Under the program, New Jersey will transition from its current any willing provider (AWP) policy, which requires a managed care organization (MCO) to contract with any nursing home who would like a contract and complies with the MCO’s provider network participation requirements, to the any willing qualified provider (AWQP) program. The AWQP program establishes the ground work for a nursing home and an MCO to negotiate a payment rate based on quality and outcomes. This program was developed in collaboration with the MLTSS Steering Committee’s Quality Workgroup which includes representatives from the nursing facility providers, the MCOs and other long-term care stakeholders and advocates.

Nursing Home Quality Metrics

DHS has designed a multi-year timeline to develop and implement the AWQP initiative. The rollout includes a “pre-baseline” data distribution of the five measures selected by the Quality Workgroup for all nursing homes participating in MLTSS. The five metrics are part of the federally mandated process for clinical assessment of residents in nursing homes certified by the Centers for Medicare & Medicaid Services as part of the Minimum Data Set (MDS).

This first data distribution is intended to serve as a learning opportunity for the nursing homes to be made aware of their performance so they can begin to design and implement quality improvement plans to improve outcomes for their residents. The focus of this initial distribution is to show how each nursing home performs on the following five selected MDS measures.

  • Is the percentage of long-stay residents who are immunized against influenza at or above the statewide average? (Statewide average; Updated September 2017: 96.45%) This metric is calculated once a year during the influenza season (October 1 – June 30).

The next four measures, in which four of the most recently available six quarters are analyzed each quarter, are looked at independently of one another. The measure could be met in any four of the most recent six quarters examined. For the purposes of this demonstration, DHS looked at quarter four of 2015; quarters one, two, three and four in 2016 and quarter one in 2017.

  • Is the percentage of long-stay residents who received an antipsychotic medication at, or below, the statewide average on a quarterly basis for 4 of the last 6 quarters for which data is available? (Statewide average; Updated September 2017: 11.75%) 
  • Is the percentage of long-stay, high-risk residents with a pressure ulcer at, or below, the statewide average on a quarterly basis for 4 of the last 6 quarters for which data is available? (Statewide average; Updated September 2017: 6.43%)
  • Is the percentage of long-stay residents who are physically restrained at or below the statewide average on a quarterly basis for 4 of the last 6 quarters for which data is available? (Statewide average; Updated September 2017: 0.74%)
  • Is the percentage of long-stay residents experiencing one or more falls with major injury at, or below, the statewide average on a quarterly basis for 4 of the last 6 quarters for which data is available? (Statewide average; Updated September 2017: 2.40%)
 
 
Other Measures

There are two other measures that are not from the MDS, which are not included in the initial rollout. The sixth measure uses CoreQ as the standardized and validated tool to measure resident and family experience with each nursing home. The seventh measure will ask if a nursing home is using INTERACT, Advancing Excellence tools, TrendTracker or another validated tool to measure 30-day hospitalizations and overall hospital utilization.

 
 
Resources for Providers:

Letter to Medicaid Nursing Facilities

Letter to Special Care Nursing Facilities

Letter to Non-Medicaid Nursing Facilities

Provider Frequently Asked Questions (FAQs)

Medicaid Nursing Homes Performance

 
 
 
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