(1) An award shall be made for the best performers for the evaluation period;

(2) An award shall be made to residential health care facilities with the best improvement in pressure ulcer care between a base and evaluation period except that facilities in the bottom quarter percentile of all eligible residential health care facilities for this evaluation period shall not be eligible for such an award if, even after their improvement in pressure ulcer care, they still remain in the bottom quarter percentile of all eligible residential health care facilities; and

(3) Residential health care facilities that qualify are eligible to receive an award in both categories of awards.

(d)(1) The evaluation period for the award for best performers shall be January 1, 2007 through December 31, 2007.

(2) The base period for the award for best improvement shall be July 1, 2006 through June 30, 2007 which shall be compared to the period July 1, 2007 through June 30, 2008.

(1) The quality measure of pressure ulcer shall be risk adjusted using such patient health factors to include but not be limited to, coma, malnutrition, diseases and conditions related to pressure ulcer, low body mass index, and plegia (paraplegia or hemiplegia);

(2) Pressure ulcer rates shall be considered only for chronic care residential health care facility residents;

(3) In order to be eligible to be considered for a rate enhancement, a residential health care facility must have averaged more than one prevented pressure ulcer per quarter of the evaluation period identified in subdivision (d) of this section as calculated by comparing the actual number of residents with a pressure ulcer to the expected number of residents with a pressure ulcer based on the facility's risk adjusted pressure ulcer rate developed pursuant to this subdivision; and

(4) Any residential health care facility receiving a written deficiency for substandard quality of care, as defined in federal regulation 42 C.F.R. § 488. 301, during the evaluation periods contained in this section shall be excluded from receiving an award under this section.

Statutory Authority:

The authority by which the Commissioner promulgates the subject regulations is contained in section 2808(22) of the Public Health Law, which requires the Commissioner to adopt rules and regulations for residential health care facility reimbursement rates that incorporate payment incentives related to certain quality of care measures.

Legislative Objectives:

The legislative intent of Article 28 of the Public Health Law is to provide for the protection and promotion of the health of the inhabitants of the State of New York by delivering high quality nursing home services in a safe and efficient manner at a reasonable cost. Section 2808(22) of the Public Health Law requires the Commissioner of Health to adopt rules and regulations that incorporate rate enhancements for nursing homes that meet certain quality measures.

Needs and Benefits:

In accordance with Public Health Law § 2808(22), the proposed amendment is needed to establish rules and regulations for a rate enhancement for improved performance in long term residential patient care. The initial round of enhancements will be based on a nursing home's risk adjusted pressure ulcer measure for chronic care residents. This quality measure produces a ratio that compares the actual rate to the expected rate of pressure ulcers at a facility.

Rate enhancements will be given to Best Performers and Best Improvers among eligible nursing homes. An eligible nursing home is one that has not been cited for substandard quality of care during the relevant period. A nursing home can be selected in both categories.

The Best Performers will consist of the top four percent of all eligible nursing homes rank ordered for the risk adjusted pressure ulcer measure. Nursing homes will be ranked according to the four quarter average score for the period January 1, 2007 to December 31, 2007.

The Best Improvers will consist of the top four percent of all eligible nursing homes showing improvement in the risk adjusted pressure ulcer measure from the base period to the evaluation period. A facility will not be eligible for a Best Improver award if its average pressure ulcer ratio for the evaluation period remains in the bottom 25th percentile of all eligible nursing homes. The base period will be July 1, 2006 to June 30, 2007. The evaluation period will be July 1, 2007 to June 30, 2008.

COSTS:

Costs to State Government:

A State appropriation has been made in the amount of $1.5 million for the 2007 State fiscal year. The State will seek approval from the Centers for Medicare and Medicaid Services to amend its Medicaid State Plan to obtain federal financial participation in the costs of providing these rate enhancements.

Costs of Local Government:

The additional cost to local government will be the local share of the Medicaid costs.

Costs to Private Regulated Parties:

There will be no additional costs to private regulated parties. The proposed regulation allows a rate enhancement if a facility meets certain quality measures.

Costs to the Department of Health:

There will be no additional costs to the Department of Health.

Local Government Mandates:

This proposal poses no program, service, duty or other responsibility upon any city, town, village, school, fire district or other special district.

Paperwork:

Providers receiving an award will be required to report to the Department its proposed use of the monies.

Duplication:

These regulations do not duplicate any other existing State or Federal regulations.

Alternatives:

To determine an appropriate quality measure or measures on which to base an award, the Department formed a workgroup consisting of representatives from a number of individual nursing homes, as well as from various organizations representing nursing homes and nursing home residents. Among the organizations represented in the workgroup were: Coalition of Institutionalized Aged & Disabled; Continuing Care Leadership Coalition; Greater New York Health Care Facilities Association; Healthcare Association of New York State; Long Term Care Community Coalition; New York Association of Homes &Services for the Aging; and New York State Health Facilities Association.

The workgroup looked at the eighteen separate performance measures established by the federal Centers for Medicare and Medicaid Services to measure quality of care in nursing homes. Three of these measures related to pressure ulcers. The workgroup determined the incidence of pressure ulcers to be a good indicator of the overall quality of care in a facility, and that New York State nursing homes most needed improvement with respect to this quality measure. For these reasons, the workgroup chose pressure ulcers as the initial quality performance measure for awarding rate enhancements pursuant to Public Health Law section 2808(22).

As an alternative, the workgroup considered evaluating nursing homes on a combination of different types of performance measures. However, the workgroup concluded that this approach would not necessarily yield more reliable results and would pose certain methodological difficulties. Therefore the workgroup ultimately concluded that the incidence of pressure ulcers would provide the best yardstick for measuring overall improvement in quality of care.

Federal Standards:

The proposed rule does not exceed any minimum standards of the federal government for the same or similar subject areas.

Compliance Schedule:

The proposed rule establishes rate enhancements for facilities that meet certain quality standards. There is no period of time necessary for regulated parties to achieve compliance.

Contact Person:

Katherine E. Ceroalo

New York State Department of Health

Bureau of House Counsel, Regulatory Affairs Unit

Corning Tower Building, Room 2438

Empire State Plaza

Albany, New York 12237

(518) 473-7488

(518) 473-2019 FAX

Comments submitted to Department personnel other than this contact person may not be included in any assessment of public comment issued for this regulation.

No Consolidated Analysis is required. The proposal will not impose an adverse economic impact on small businesses or local governments and will not impose additional reporting, recordkeeping or other compliance requirements. The proposal simply increases Medicaid reimbursement to nursing homes that meet or exceed certain performance measures as defined in Department regulations.

No Rural Area Flexibility Analysis is required. The proposal will not impose an adverse economic impact on rural areas nor impose additional reporting, recordkeeping or other compliance requirements on public or private entities in rural areas. The proposal simply increases Medicaid reimbursement to nursing homes that meet or exceed certain performance measures defined in Department regulations.

A Job Impact Statement is not attached because it is apparent, from the nature and purpose of the proposed rule, that it will not have a substantial adverse impact on jobs or employment opportunities. The proposal simply increases Medicaid reimbursement to nursing homes that meet or exceed certain performance measures as defined in Department regulations.