Sec. 10.09.10.15. Pay-for-Performance — Quality Measures

A. Providers shall receive a composite score based on the following:

(1) Staffing levels and staff stability, as described in §§B and C of this regulation, shall comprise 40 percent of each facility’s score;

(2) Maryland Health Care Commission Nursing Facility Family Survey, as described in §D of this regulation, shall comprise 40 percent of each facility’s score;

(3) Minimum Data Set Clinical Quality Indicators, as described in §E of this regulation, shall comprise 16 percent of each facility’s score;

(4) Employment of an infection control coordinator, as described in §F of this regulation, shall comprise 2 percent of each facility’s score; and

(5) Staff immunization survey, as described in §G of this regulation, shall comprise 2 percent of each facility’s score.

B. Staffing Levels.

(1) Maryland nursing facilities serving Medicaid patients shall provide salary data and hours of work data at least 3 months before the start of the new rate year. These data shall be for selected personnel types for a 2-week period to be specified by the Department.

(2) Each Maryland facility covered by these regulations which fails to comply with §B(1) of this regulation shall incur a 1 percentage point reduction in its applicable rental rate presented in Regulation .11B(1)(i) or (j) of this chapter.

(3) A facility’s average staffing level shall be determined from its most recent data reported in accordance with §B(1) of this regulation. Total staff hours shall be divided by average daily census during the survey period in order to establish the facility’s average daily staffing.

(4) A facility’s average acuity shall be determined based on the facilities Minimum Data Set Resource Utilization Groups (RUG) during the 6-month period ending December 31 of the most recent State fiscal year. To establish expected staffing hours, each RUG group will be multiplied by the corresponding hours under Regulation .31B of this chapter and divided by the total days of care during the same period.

(5) The result from §B(4) of this regulation shall be multiplied by 1.26555 in order to establish the facility’s staffing goal.

(6) The facility’s staffing level from §B(3) of this regulation shall be divided by the facility’s staffing goal from §B(5) of this regulation in order to determine a score based on its percentage of the goal. A facility staffing exceeding its goal shall be scored at 100 percent.

(7) Providers shall receive 0-20 points based upon the scoring methodology described under Regulation .16 of this chapter.

C. Staff Stability.

(1) Staff stability is based upon dates of employment for nursing staff reported on the facility’s most recent salary and hours survey in accordance with §B(1) of this regulation.

(2) Staff stability shall be determined by the percentage of hours provided by staff employed by the facility for 2 years or longer at the time of the survey.

(3) Providers shall receive 0-20 points based upon the scoring methodology described under Regulation .16 of this chapter.

D. Family Satisfaction.

(1) Family satisfaction shall be determined based on results from the facility’s most recent Nursing Facility Family Survey administered by the Maryland Health Care Commission.

(2) Providers shall receive 0-40 points based upon the scoring methodology described under Regulation .16 of this chapter, as follows:

(a) 0-20 points shall be based upon questions regarding general satisfaction; and

(b) 0-20 points shall be based on several categories of questions regarding specific aspects of care and environment in the nursing facility.

E. Minimum Data Set Clinical Quality Indicators.

(1) Providers shall receive scores for the 3-month period ending December 31 of the most recent prior State fiscal year based on the following quality indicators for long-stay residents from the Minimum Data Set published by the federal Centers for Medicare and Medicaid Services:

(a) Percent of High-Risk Residents Who Have Pressure Sores;

(b) Percent of Residents Who Were Physically Restrained;

(c) Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder;

(d) Percent of Residents with a Urinary Tract Infection;

(e) Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season; and

(f) Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination.

(2) Providers shall receive 0-2.67 points for each quality indicator based on the scoring methodology described under Regulation .16 of this chapter.

F. Employment of Infection Control Coordinator.

(1) In accordance with State licensing regulations under COMAR 10.07.02.21, all Maryland nursing facilities are required to employ an infection control coordinator who has attended training as required in COMAR 10.07.02.21C. Scoring, based on compliance with COMAR 10.07.02.21, shall be as follows:

(a) A facility not in compliance with COMAR 10.07.02.21 shall receive no points;

(b) A facility meeting the minimum requirement of COMAR 10.07.02.21 shall receive 1 point; or

(c) A facility shall receive 2 points if:

(i) In a facility with 200 or more beds, an infection control coordinator is dedicated 35 hours or more per week to infection control responsibilities; or

(ii) In a facility with fewer than 200 beds, an infection control coordinator is dedicated to infection control responsibilities 15 hours or more per week.

(2) Providers shall receive 0-2 points for this quality measure. Data will be collected by the Department in April of each year.

G. Staff Immunizations.

(1) Providers shall receive a score based on the percentage of nursing facility staff, which includes all staff classifications, that have been vaccinated against seasonal influenza.

(2) Providers shall receive 0 or 2 points for this quality measure. Facilities shall submit data to the Department regarding all individuals employed or contracted by the facility during the period September through April 15.

(3) Benchmark.

(a) The benchmark for staff vaccinations is 80 percent.

(b) Nursing facilities that meet or exceed the benchmark of 80 percent for seasonal flu shall receive 2 points.

(c) Facilities with less than 80 percent may not receive points for this quality measure.