By Monnette Geronimo, manager, Business Development
Florida nursing homes still seeking to receive incentive payments this fall under Florida’s Medicaid Prospective Payment System (PPS) must act quickly to meet the May 31, 2021 deadline.
Under Florida’s Medicaid PPS, nursing homes need to achieve specific quality metrics and outcomes, including a recognized quality credential such as The Joint Commission’s Nursing Care Center accreditation, to receive additional quality incentive payments (QIP) or reimbursements.
Florida’s PPS quality measures are grouped into three major categories:
- Process measures – actions that directly impact residents such as the use of restraints and the distribution rates of flu vaccinations and anti-psychotic medications
- Outcomes measures – impact of care on residents such as a lower percentage of urinary tract infections (UTI), pressure ulcers, falls, incontinence and need for assistance with activities of daily living (ADL)
- Structural measures – organizational characteristics associated with the provision of care such as staffing ratios, performance in the Centers for Medicare & Medicaid Services (CMS) Five Star Quality ratings and achievement of an established quality credential such accreditation from The Joint Commission
The Joint Commission’s Approach
To receive QIP payments this fall, Florida nursing homes must have their quality credential in place by May 31, 2021. Here’s how we are helping many organizations achieve this:
Mindfulness: We've updated our survey protocols and implemented a virtual survey process for organizations unable to conduct on-site surveys. We've also gathered resources to help organization(s) address key infection prevention and emergency management challenges during the COVID-19 pandemic.
Flexibility: Unlike other quality credential options, there are no blackout dates for the application – allowing organizations to apply throughout the year. Also, there are no progressive levels to achieve Joint Commission accreditation and organizations may achieve accreditation after their first survey.
Results: A JAMDA study using public data from CMS Nursing Home Compare revealed a consistent pattern of superior performance among Joint Commission accredited nursing homes on a variety of measures including:
- flu vaccination rates
- anti-psychotic medication rates
- incidence of pressure ulcers, falls and need for assistance with activities of daily living (ADL)
These are the very same quality measures tracked in the Florida PPS.
Expertise: Joint Commission accreditation standards are designed to act as a framework for performance improvement. Surveyors are trained to bring best practices from observations they make nationwide. This opens opportunities for improvements that may not be apparent without the basis for comparison.
Value: Access our recent on-demand webinar How to Optimize Your Reimbursement for Florida’s 2021 PPS to learn more about the financial relationship between potential additional reimbursement and accreditation.
Hold Harmless Rate
2021 also marks the year when re-basing of rates is set to occur. When Florida’s Medicaid PPS took effect in 2018, it included a 3-year hold harmless period to ease transition to the new payment program. This is the year of the PPS where rates will be updated based on new audited cost reports. If, based on re-basing, a facility being paid under its hold harmless rate continues to have a higher hold harmless rate than its PPS rate, the hold harmless rate could get reduced by 5%.
There's also a possibility for quality cut points and thresholds to update in 2021. The idea being, as improvements are achieved by providers across the different quality measures, the metrics and cut points may be revisited and adjusted to support continuous improvement in specific measures or areas.
I’m happy to speak personally in more depth about increasing PPS points and reimbursement, the hold harmless rate or acquiring points under the PPS.
But don't wait too long to reach out, the May 31st deadline is approaching quickly! Contact me directly at or 630-792-5251 so we can get you started.
Monnette Geronimo is the program manager of the Joint Commission’s Nursing Care Center Accreditation program. In this role she advises health care organizations on the value of accreditation and how to strategically leverage the program to support business objectives. Geronimo is trained in Robust Process Improvement (RPI), a blended approach that incorporates lean, six sigma, and change management to increase the efficiency of business processes and the quality of products and services. She is a certified RPI® Yellow Belt and Change Agent. Prior to Joint Commission, Geronimo worked in the life and health insurance industry where she is a designated Fellow of the Life Management Institute (FLMI).