The Quality Incentive Payment Program (QIPP) gives nursing facilities in New Jersey the opportunity to earn bonus payments if they achieve specific quality and performance goals that are essential to providing appropriate resident care. Each facility is eligible to earn an additional payments per resident per day on top of their normal rate for residents that are Medicaid members based on the number of quality benchmarks that the facility achieves. The program is a collaboration between the Division of Aging and the Division of Medical Assistance and Health Service (DMAHS), which administers the state’s Medicaid program (NJ FamilyCare), within the Department of Human Services.

For the current fiscal year, 2025, in order to receive QIPP bonus payments, nursing facilities are compared against the state or national average, whichever is more stringent, on each of the following quality performance standards (QPS):

QPS 1: Total Nurse Staffing Hours Adjusted

• Metric is selected from the CMS Payroll Based Journal. The data and benchmarks are established and collected by CMS and calculated by the Department. CMS staff measure where the nursing facility has not failed to report data for any of the reporting periods Q4 2022, Q1 2023, Q2 2023 and Q3 2023.
  • Asterisk Symbol (*) indicates CMS had a footnote of "The number of residents is too small to report. Call the facility to discuss the quality measure."
  • Three Dashes Symbol (---) indicates CMS had a footnote of "The data for this measure is missing. Call the facility to discuss the quality measure." A data period with dashes will result in failure to meet the metric benchmark due to the facility's failure to report required data.

Tiered Payments

• • Tier 1 benchmark: 4.1 Hours Per Resident Day (HPRD), a benchmark cited frequently in research as a high-quality standard for nursing home staffing quality. Add-on Amount: $6.75
  • Tier 2 benchmark = 3.8 HPRD (state average) with a lower dollar value than Tier 1. Add-on amount: $4.50
  • Tier 3 benchmark = 3.6 HPRD. No Add-on amount; used to determine minimum eligibility for Improvement Payment

Improvement Payment

• • Facilities that achieve a minimum benchmark of 3.6 HPRD (tier 3 benchmark) and demonstrate improvement of at least .5% from the prior fiscal year will be eligible for an add-on with a lower dollar value than Tier 1 and Tier 2.
  • Only Tier 2 & Tier 3 facilities are eligible for an improvement add-on.

QPS 2: Total Nurse Staffing-Adjusted Improvement (Difference from Prior Year Average)

• Metric is selected from the CMS Payroll Based Journal. The data and benchmarks are established and collected by CMS and calculated by the Department. CMS staff measures where the nursing facility has not failed to reported any data for any of the reporting periods Q4 2021, Q1 2022, Q2 2022, Q3 2022, Q4 2022, Q1 2023, Q2 2023 and Q3 2023 and the simple average of Q4 2022, Q1 2023, Q2 2023 and Q3 2023, as calculated by the Department using available data, is equal to or greater than 100.5% of the simple average of Q4 2021, Q1 2022, Q2 2022, and Q3 2022, as calculated by the Department using available data, and is at or above 3.6 hours per resident day and below 4.1 hours per resident day, as calculated by CMS, for total nurse staffing adjusted hours per resident day. Add-on Amount: $1.25

QPS 3: Total Nursing Staff Turnover

• Metric is selected from the CMS Payroll Based Journal. The data and benchmarks are established and collected by CMS and calculated by the Department. CMS staff measure where the nursing facility has not failed to report data for any of the reporting periods Q4 2022, Q1 2023, Q2 2023 and Q3 2023. Add-on Amount: $4.50
  • Asterisk Symbol (*) indicates CMS had a footnote of "The number of residents is too small to report. Call the facility to discuss the quality measure."
  • Three Dashes Symbol (---) indicates CMS had a footnote of "The data for this measure is missing. Call the facility to discuss the quality measure." A data period with dashes will result in failure to meet the metric benchmark due to the facility's failure to report required data.

QPS 4 - 5: Lose Too Much Weight 404 & Pressure Ulcers 453

• Metrics are selected from the CMS Nursing Home Quality Initiative. The data and benchmarks are established, collected, and calculated by CMS. The national and/or state averages are calculated by the DHS based on the data available for four calendar year quarters: Q4 2022, Q1 2023, Q2 2023 and Q3 2023. The more stringent of the National or State average is used as the benchmark for earning a quality payment. Note: QPS 4 uses the State average. QPS 5 uses the National average. Add-on Amount per Measure: $3.00
  • Asterisk Symbol (*) indicates CMS had a footnote of "The number of residents is too small to report. Call the facility to discuss the quality measure."
  • Three Dashes Symbol (---) indicates CMS had a footnote of "The data for this measure is missing. Call the facility to discuss the quality measure." A data period with dashes will result in failure to meet the metric benchmark due to the facility's failure to report required data.

QPS 6: Number of Hospitalizations Per 1000 Long-Stay Resident Days 551

• Metric is selected from the CMS Nursing Home Quality Initiative. The data and benchmark is established, collected, and calculated by CMS. The national average is calculated by the DHS based on the data available for four calendar year quarters: Q3 2022, Q4 2022, Q1 2023 and Q2 2023. The National average is used as the benchmark for earning a quality payment. Add-on Amount: $3.00
  • Asterisk Symbol (*) indicates CMS had a footnote of "The number of residents is too small to report. Call the facility to discuss the quality measure."
  • Three Dashes Symbol (---) indicates CMS had a footnote of "The data for this measure is missing. Call the facility to discuss the quality measure." A data period with dashes will result in failure to meet the metric benchmark due to the facility's failure to report required data.

QPS 7: CoreQ

• Reflects the results of an annual nursing home satisfaction survey. This survey was given to long-stay families and their families. Three questions rate the facility overall, the staff, and the care received. Responses are scored as follows: 1 (poor), 2 (average), 3 (good), 4 (very good) and 5 (excellent). CoreQ eligibility is established by having valid sample size and a responsiveness to the required information. A composite score of 85% or higher is required to meet the benchmark. Add on Amount: $3.00
  • Facilities who participated in the survey, but with insufficient survey responses for scoring are marked "NS" for No Score.
  • Facilities eligible for NF QIPP, but not able to meet a minimum survey sample size are marked "N/A" for Not Applicable.
  • Facilities who did not provide the mandatory CoreQ Survey Sample Size Calculation Grid are deemed ineligible for both CoreQ participation and QIPP. These facilities are marked "NE" for Not Eligible.

Long term care facilities are not permitted to earn bonus payments through QIPP if they meet any of the following exclusion criteria:

• Failure to submit the annual mandatory NF QIPP requirements
  • Each Medicaid long term care facility is required to submit information to the Department regarding the facility ability to participate in the CoreQ resident and family satisfaction surveys.
• Inclusion on CMS Special Focus Facility Lists A, B, E, F
  • The Center for Medicare and Medicaid Studies (CMS) Special Focus Facility program identifies facilities that are cited for a high number of deficiencies and/or deficiencies that are more severe during health inspections. These facilities are inspected more frequently by the Department of Health (DOH) and may receive penalties for their performance they do not show improvement.
• CMS Star Rating of 1
  • CMS uses a five-star rating system to rate the quality of nursing homes within each state. A rating of 5 indicates significantly above average quality, and a rating of 1 indicates significantly below average quality.
• Citation by Department of Health for 2 or more Level G or higher licensing violations
  • Licensing violations categorized as G, H, or I indicate that actual harm has occurred, but that no residents were in immediate jeopardy. Violations categorized as J, K, or L indicate that DOH noted an immediate jeopardy to resident health or safety.

Information about QIPP bonus payments earned by specific facilities in New Jersey can be viewed below:

This reflects the daily rate paid to licensed long-term care facilities for each Medicaid-enrolled individual they serve by Fiscal Year.

Division of Aging Services | Nursing Facilities Resources (nj.gov)

The New Jersey Department of Health (DOH) hosts a Nursing Home Facility Data Dashboard that provides detailed information on the quality of long term care facilities throughout the state. Users can search for facilities by name, county, federal CMS star rating, Special Focus Facility status, payment type, and specialty.

In addition to basic information about a facility’s location, size, number of residents, staffing levels, and contact information, the Data Dashboard provides a breakdown of a facility’s federal CMS star rating based on the three sources that inform it: quality of care measures, staffing, and health inspections and complaints. Each sub-metric is rated on a scale of one to five, and the dashboard includes information about the facility’s performance on key factors that influence a facility’s score.

The DOH website also has a page on Long Term Care Resources that includes other helpful information regarding long term care facilities, such as a vaccination coverage data dashboard, list of current outbreaks in long term care facilities, and a collection of additional resources from the New Jersey, CMS, and CDC.

This office investigates and responds to complaints of abuse, neglect, and exploitation of individuals 60 years of age and older who reside in licensed facilities within the State, both public and private. To make a report, call 1-877-582-6995.

Like the DOH Data Dashboard, the Care Compare website allows you to search for long term care facilities and get detailed information about their quality metrics and federal CMS star rating. Care Compare includes information about long term care facilities from across the entire United States.

The Aging and Disability Resource Connection (ADRC) serves as a visible and trusted source of information on long term care services and supports for persons of all incomes. For information that can help you make informed decisions about long term care services and supports, visit the ADRC website, or contact the ADRC via phone at 1-877-222-3737.

The ADRC also offers A Guide to Community-Based Long Term Care in New Jersey, a handbook that provides important information on both public and privately funded long term care services and supports to help with making decisions about care and locating resources.

I Choose Home NJ is a Federal program with two main goals: 1) move people out of nursing homes and developmental centers back into the community; and 2) reinvest Medicaid dollars saved back into home and community-based services to grow the system. Residents who are eligible for Medicaid and have been living in a nursing facility for more than 60 days may be able to move to an independent community setting with supports and services. I Choose Home NJ staff can provide information and assistance with transitions to a community setting.

I CHOOSE HOME NJ WEBSITE: I Choose Home NJ