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 paid Medicaid days that have been open for at least ten months of the respective Federal Fiscal Year (FFY).
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 is: 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 Quality Measure (QM) Incentive Payment is calculated using the total legislature-allocated funds, divided by a weighted sum of eligible nursing facility (NF) Medicaid days reported during the Federal Fiscal Year (FFY). Each Medicaid day is weighted according to the facility's performance tier: Tier 1 days are weighted at 100%, Tier 2 at 85%, and Tier 3 at 60%. Tier 4 days are not included in the calculation and are not eligible for incentive funds. Once the weighted per-day value is determined, each facility’s payment is calculated by multiplying the number of Medicaid days by the weighted base payment and corresponding performance tier percentage, resulting in a graduated payment structure based on both performance tier and number of days.
All monies will be distributed annually as individual payments 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.
| Tier | Base Payment % |
| 1 | 100% |
| 2 | 85% |
| 3 | 60% |
| 4 | 0 |