What the NHQI is
The Nursing Home Quality Initiative is how the New York State Department of Health scores Medicaid nursing homes against each other. The score decides a building's share of the Nursing Home Quality Pool, set in regulation at 10 NYCRR 86-2.42 at $50 million a year.
The pool is budget-neutral. It isn't new money. Every home in the NHQI pays in through a Medicaid rate reduction sized to its Medicaid revenue, and DOH pays the pool back out to the homes in the top three quintiles. So a home in the bottom two quintiles doesn't just miss a bonus. It pays for everyone else's.
How the 90 points are built
The 2025 NHQI, DOH's current methodology, has three parts:
| Part | Points |
|---|---|
| Quality: 13 measures, 5 points each | 65 |
| Compliance: health inspection star, regionally adjusted | 10 |
| Compliance: staff flu vaccination data submitted on time | 5 |
| Efficiency: potentially avoidable hospitalizations | 10 |
| Maximum | 90 |
The 13 quality measures
| Measure | Scored by |
|---|---|
| Urinary tract infection (long-stay) | 5% or less |
| Falls with major injury (long-stay) | 5% or less |
| Contract or agency staff used | under 10% |
| Pressure ulcers (long-stay) | Quintile |
| New or worsened bowel or bladder incontinence | Quintile |
| Depressive symptoms | Quintile |
| Lose too much weight | Quintile |
| Need for help with daily activities increased | Quintile |
| Pneumococcal vaccine | Quintile |
| Seasonal influenza vaccine | Quintile |
| Employees vaccinated for influenza | Quintile |
| Staffing hours per resident per day | Quintile |
| Total nursing staff turnover | Quintile |
A threshold measure pays all 5 points or none. A quintile measure pays 5 points in the best fifth of New York homes, 3 in the second, 1 in the third and nothing below that. Quintile measures also pay for improvement: a home that moves from the third quintile to the second gets 4 points instead of 3. DOH risk-adjusts pressure ulcers, incontinence and weight loss itself, and adjusts turnover by region.
The health inspection points come from CMS's survey scores, re-starred within four New York regions: 10 points for 5 stars, then 7, 4, 2 and 0. Avoidable hospitalizations pay 10, 8, 6, 2 or 0 points by quintile.
When a measure can't be scored because the sample is too small, it comes out of the denominator instead of scoring zero. A home with 75 points out of a possible 80 scores 94, not 83.
How the pool pays
DOH ranks every scored home into quintiles by overall score. Each home's contribution is its share of statewide Medicaid revenue (its January 1 Medicaid rate times its Medicaid days) times $50 million.
The pool is then paid back only to quintiles 1, 2 and 3, weighted by Medicaid revenue times an award factor:
| Quintile | Award factor |
|---|---|
| 1 (best) | 3 |
| 2 | 2.25 |
| 3 | 1.5 |
| 4 and 5 | Nothing back |
If the three paid quintiles held equal Medicaid revenue, a first-quintile home would get back about 2.2 times what it paid in, a second-quintile home about 1.7 times and a third-quintile home about 1.1 times. Real quintiles aren't equal, so treat those as rough, but the shape holds: the third quintile roughly breaks even, and the line between the third and fourth is where a home stops being paid.
One deficiency overrides all of it. A J, K or L deficiency between July 1 of the measurement year and June 30 of the payment year means no payout, whatever the quintile. In the 2024 NHQI, 29 homes were set aside this way.
See your building’s stars and every long-stay measure against the nation.
When your work shows up
Each NHQI scores one calendar year of care. The 2025 NHQI reads MDS data from calendar 2024, the 2024 flu season, and CMS's April 2025 inspection scores.
The money comes later still. The 2023 NHQI, built on 2022 care, was finalized in January 2025, and its pool was paid in May 2025. That is about two and a half years from care to cash, and it is why a home can't wait for the score to find out how the year went.
What moves the score
- The two 5% lines. UTI and falls with major injury pay 5 points or zero. On a unit of 50 long-stay residents, one resident is 2 percentage points, so one resident can be the whole 5 points.
- UTIs only when they meet the definition. I2300 needs both the evidence-based criteria and a physician diagnosis in the 30-day look-back.
- Code J1900C exactly. Major injury means a fracture, a dislocation, a closed head injury with altered consciousness, or a subdural hematoma.
- Five points for a filing. Staff flu vaccination data submitted to DOH by the deadline is worth 5 points on its own.
- Agency staff under 10%. The contract staffing measure is another all-or-nothing 5 points, and it belongs to the administrator.
- Improvement counts. A quintile measure that climbs a quintile earns an extra point, so a measure that isn't in the top fifth is still worth working.
How SuperQM helps New York homes
SuperQM builds the long-stay measures the NHQI scores from your own charting, for the year you're in, and shows UTI and falls against New York's 5% lines. When a resident is about to tip a measure, or a code doesn't match the chart, the right person hears about it that day, while there's still time to fix it. See how SuperQM works.
