Nursing Home Quality

Quality Incentive Payment Program (QIPP)

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 $1.80 to $12.60 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, 2024, 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 metrics:

  • Use of physical restraints
    • Defined as percent of long-stay nursing facility residents who are physically restrained on a daily basis. Physical restraints is identified as trunk or limb restraint used in bed or chair; or chair prevents rising in chair or out of bed.
  • Falls with major injury
    • Defined as percent of long-stay nursing facility residents who have experienced one or more falls with major injury.
  • Antipsychotic medication use
    • Defined as percent of long-stay residents who are receiving antipsychotic drugs. Individuals diagnosed with Schizophrenia, Tourette’s syndrome, or Huntington’s disease are excluded.
  • Incidence of pressure ulcers
    • Defined as percent of high risk, long-stay residents with Stage 2, 3 or 4 pressure ulcers.
  • Influenza vaccinations
    • Defined as percent of long-stay residents who are assessed and/or given, appropriately, the influenza vaccination during the influenza season. Resident assessment and appropriate provision is measured; vaccination may be voluntarily declined or determined medically ineligible.
  • Number of hospitalizations per 1000 long-stay resident days
    • Defined as the number of unplanned inpatient admissions or outpatient observation stays that occurred among long-stay residents during a one-year period, expressed as the number of unplanned hospitalizations for every 1,000 days that long-stay residents were admitted to the facility.
  • CoreQ long-stay resident and family satisfaction survey results
    • Defined as a short, reliable, and validated questionnaire to calculate the level of satisfaction for long-stay residents and their families.

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 or meet the annual mandatory NF QIPP requirements
    • Each Medicaid long term care facility is required to attest to the use of software systems to track hospital utilization; and 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:

Nursing Home Rates for FFS Residents

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

DOH Nursing Home Facility Data Dashboard

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.

Long Term Care Ombudsman

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.

CMS Care Compare website

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.

Aging and Disability Resource Connection (ADRC)

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

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