The two long-stay vaccine measures on Care Compare don’t ask whether every resident was vaccinated. They ask whether every resident was assessed and appropriately vaccinated: given the vaccine, offered it and declined, or found not eligible. What counts against the building is, mostly, a vaccine that was never offered or a status nobody recorded.
Which measures, and where they’re used
| Measure | Item | How often it’s calculated |
|---|---|---|
| N016.03 Assessed and appropriately given the seasonal influenza vaccine | O0250 | Once per influenza season |
| N020.02 Assessed and appropriately given the pneumococcal vaccine | O0300 | From each resident’s target assessment, like the other long-stay measures |
- Care Compare: yes. Five-Star: no. CMS also calculates the pieces of each measure (received, declined, not eligible) as separate measures, but those appear only in the Provider Preview reports.
- Florida’s QIP scores the long-stay influenza measure, N016. See Florida QIP, explained.
- New York’s NHQI 2025 methodology scores the percent of long-stay residents who received each vaccine (its measure names), rather than the “assessed and appropriately given” versions on Care Compare.
Neither measure is risk-adjusted.
Influenza: what counts
On the resident’s influenza vaccination assessment, any of these is a success:
- O0250A = 1: received in this facility this season
- O0250C = 2: received outside the facility
- O0250C = 3: not eligible, medical contraindication
- O0250C = 4: offered and declined
Anything else is not: 5, not offered; 6, unable to obtain because of a declared shortage; 9, none of the above; or 1, not in the facility this season.
Influenza: the season and the timing
“This measure is only calculated once per 12-month influenza season which begins on July 1 of a given year and ends on June 30 of the subsequent year and reports data for residents who were in the facility for at least one day during the target period of October 1 through March 31.”
In practice:
- Who is in it: long-stay residents who entered on or before March 31 and have a qualifying assessment dated from October 1 through June 30. For these measures, long stay is judged as of March 31.
- Which assessment is read: the latest qualifying assessment in that October-to-June window. The June 30 end catches residents vaccinated over the winter whose next assessment falls after March.
- When it’s calculated: once a year, after the season ends in June.
“Once the influenza vaccination has been administered to a resident for the current influenza season, this value is carried forward until the new influenza season begins.”
A worked example. Resident H is a long-stay resident who got the flu vaccine in the building in October. The quarterly in January codes O0250A = 1, and so does the quarterly in April, carried forward. The April assessment is the latest in the window, and it shows the vaccine, so Resident H is a success for the season. Had the April quarterly coded O0250C = 9 because nobody looked back, the season would count Resident H as a miss.
Pneumococcal: what counts
On the target assessment, any of these is a success:
- O0300A = 1: vaccination is up to date
- O0300B = 1: not eligible (medical contraindication, or a physician order not to immunize)
- O0300B = 2: offered and declined
The one that counts against the building is O0300B = 3, not offered. Every long-stay resident with a target assessment is in the denominator. There are no exclusions.
“Up to date” means up to date with the current ACIP recommendations, which have changed as newer vaccines arrived. A resident who is between doses is still up to date:
“If a resident has received one or more pneumococcal vaccinations and is indicated to get an additional pneumococcal vaccination but is not yet eligible for the next vaccination because the recommended time interval between vaccines has not lapsed, O0300A is coded 1, yes, indicating the resident’s pneumococcal vaccination is up to date.”
Common coding mistakes
- An offer with no record. For the flu vaccine, “offered and declined” means the resident or their representative was informed of the risks and benefits and chose not to accept it. Chart the offer and the answer, so the code has something behind it.
- Missing an outside dose. A flu shot at the doctor’s office, a hospital or a health fair is O0250C = 2. The RAI Manual’s steps are the record, then the resident, then the family or physician.
- Settling for 9. Code 9 is a miss for the measure. When status can’t be determined, the RAI Manual’s last step is to give the vaccine according to standards of clinical practice.
- Stopping at the first pneumococcal vaccine. A resident who had one vaccine years ago may not be up to date under the current schedule. Check the ACIP guidance the RAI Manual points to.
See your building’s flu and pneumococcal vaccine rates against the nation, free.
SuperQM scores the flu measure from each resident’s latest assessment in the October-to-June window, so a resident coded as a miss can be checked while the season is still open.
