# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 10 — Nursing Facility Services

#### Regulation .15 Pay-for-Performance — Quality Measures.

*COMAR 10.09.10.15*

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

  (1) Staffing levels, as described in §B of this regulation, shall comprise 20 percent of each facility’s score;

  (2) Staffing stability, as described in §C of this regulation, shall comprise 15 percent of each facility’s score;

  (3) Maryland Health Care Commission Nursing Facility Family Survey, as described in §D of this regulation, shall comprise 30 percent of each facility’s score;

  (4) Minimum Data Set Clinical Quality Indicators, as described in §E of this regulation, shall comprise 30 percent of each facility’s score; and

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

B. Staffing Levels.

  (1) Staffing and hours of work shall be determined using the Payroll-Based Journal data for the 9-month period ending March 31 of each fiscal year.

  (2) 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 period specified in §B(1) of this regulation to establish the facility’s average daily staffing.

  (3) 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.

  (4) The result from §B(3) of this regulation shall be multiplied by 1.26555 to establish the facility’s staffing goal.

  (5) The facility’s staffing level from §B(2) of this regulation shall be divided by the facility’s staffing goal from §B(4) of this regulation to determine a score based on its percentage of the goal. A facility staffing exceeding its goal shall be scored at 100 percent.

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

C. Staff Stability.

  (1) On or before May 31 of the fiscal year, nursing facilities, excluding continuing care retirement communities and facilities with fewer than 45 beds, shall report data on individual nursing staff members’ length of employment using a format and procedures designated by the Department. This data shall include all nursing staff employed by the facility during the pay period that includes March 31 of the fiscal year.

  (2) Providers that fail to comply with §C(1) of this regulation shall receive 0 points.

  (3) Staff stability is based upon dates of employment for nursing staff reported in accordance with §C(1) of this regulation.

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

  (5) Providers shall receive 0—15 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—30 points based upon the scoring methodology described under Regulation .16 of this chapter, as follows:

    (a) 0—6 points shall be based upon questions regarding general satisfaction; and

    (b) 0—24 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 with a Fall Resulting in Major Injury;

    (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—5 points for each quality indicator based on the scoring methodology described under Regulation .16 of this chapter.

F. 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, 2, or 5 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 90 percent.

    (b) Nursing facilities that achieve the benchmark for at least 90 percent but less than 95 percent for seasonal flu shall receive 2 points.

    (c) Nursing facilities that meet or exceed the benchmark of 95 percent for seasonal flu shall receive 5 points.

    (d) Facilities with less than 90 percent may not receive points for this quality measure.