First Nursing Home Infection Control Incentive Payment Arriving Nov. 2 -- UPDATED

Regulation | November 18, 2020 | by Nicole Fallon

According to the U.S. Department of Health and Human Services (HHS)  Oct 28 announcement, nursing homes improved on their infection control performance between August and September with 76% of them, nationally, eligible for an Infection Control Incentive Payment under the targeted distribution from the Provider Relief Fund. As such, a total of $333 million will be distributed to more than 10,000 nursing homes in two payments. The first arriving on Nov. 2 representing 80% of the amount and the remainder of the funds will be distributed upon completion of the HHS data collection of mortality information.

To be eligible for an Infection Control Incentive Payment, providers must meet two "gateway" criteria: 1) the nursing home's infection rate must be lower than that of the infection rate in their county; AND 2) the nursing home's mortality rate for residents must be less than 10% for all residents in their facility that contracted COVID-19 (includes both in-facility acquired infections as well as COVID admissions). UPDATE - It should also be noted that nursing homes are required to submit their NHSN COVID-19 data that passes NHSN data quality checks for each week in the peformance data period and the six weeks prior to the performance period.

Similar to SNF Value-Based Payments, the amount of the incentive payments received by individual nursing homes will vary depending upon their total performance score. HHS first calculates the nursing homes infection control measure score and then modifies that score up or down based upon their mortality performance. The mortality measure is rate adjusted for age, gender and type of resident (Medicare-covered vs. long-term residents). For this first monthly payment that score was determined based upon infection rates and mortality from August 31 through Sept 27 data reported into NHSN and obtained directly from nursing homes related to their mortality rates.

Nursing homes’ performance improved with 5,000+ fewer infections and 1,200 fewer deaths occurring in September than in August. Twelve states had 80% or more of their nursing homes receiving incentive payments through the program. While 6 states had fewer than 50% of their nursing homes receiving payments. See chart for full list of states.

UPDATE- HHS shared its document entitled, "Nursing Home Quality Incentive Program Methodology" which describes the measures, methodology and data it is using to calculate performance payments. At this time, HHS has only published information on the number of nursing homes in each state that will receive an incentive payment and the total amount of payments going to those nursing homes in each state. HHS has not yet shared a facility-level list of nursing homes that received payments on Nov. 2 nor the amount of those payments. LeadingAge has requested this information from HHS.  Therefore, at this time, we can reach no conclusions why some states received such a large amount for their nursing homes while others were much smaller. 

HHS will be distirbuting a second portion of the September payments in mid-November that reflects additional information from those nursing homes who had one or more deaths during the performance period. 

The next monthly payment will be based upon "October" performance which encompasses NHSN COVID-19 data for the period Sept 28 – Nov. 1  These payments are anticipated to go out to qualifying nursing homes sometime the last two weeks of November.