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performance threshold receive fifteen points. Facilities in the 1 bottom performance threshold level receive no points. Points from all 2 quality measures must then be summed into a single aggregate quality 3 score for each facility. 4 (e) Facilities receiving an aggregate quality score of eighty 5 percent of the overall available total score or higher must be placed 6 in the highest tier (tier V), facilities receiving an aggregate score 7 of between seventy and seventy-nine percent of the overall available 8 total score must be placed in the second highest tier (tier IV), 9 facilities receiving an aggregate score of between sixty and sixty- 10 nine percent of the overall available total score must be placed in 11 the third highest tier (tier III), facilities receiving an aggregate 12 score of between fifty and fifty-nine percent of the overall 13 available total score must be placed in the fourth highest tier (tier 14 II), and facilities receiving less than fifty percent of the overall 15 available total score must be placed in the lowest tier (tier I). 16 (f) The tier system must be used to determine the amount of each 17 facility's per patient day quality incentive component. The per 18 patient day quality incentive component for tier IV is seventy-five 19 percent of the per patient day quality incentive component for tier 20 V, the per patient day quality incentive component for tier III is 21 fifty percent of the per patient day quality incentive component for 22 tier V, and the per patient day quality incentive component for tier 23 II is twenty-five percent of the per patient day quality incentive 24 component for tier V. Facilities in tier I receive no quality 25 incentive component. 26 (g) Tier system payments must be set in a manner that ensures 27 that the entire biennial appropriation for the quality incentive 28 program is allocated. 29 (h) Facilities with insufficient three-quarter average centers 30 for medicare and medicaid services quality data must be assigned to 31 the tier corresponding to their five-star quality rating. Facilities 32 with a five-star quality rating must be assigned to the highest tier 33 (tier V) and facilities with a one-star quality rating must be 34 assigned to the lowest tier (tier I). The use of a facility's five- 35 star quality rating shall only occur in the case of insufficient 36 centers for medicare and medicaid services minimum data set 37 information. 38 (i) The quality incentive rates must be adjusted semiannually on 39 July 1 and January 1 of each year using, at a minimum, the most 40 p. 1394 ESSB 5187.SL