Page 704

(f) The tier system must be used to determine the amount of each 1 facility's per patient day quality incentive component. The per 2 patient day quality incentive component for tier IV is seventy-five 3 percent of the per patient day quality incentive component for tier 4 V, the per patient day quality incentive component for tier III is 5 fifty percent of the per patient day quality incentive component for 6 tier V, and the per patient day quality incentive component for tier 7 II is twenty-five percent of the per patient day quality incentive 8 component for tier V. Facilities in tier I receive no quality 9 incentive component. 10 (g) Tier system payments must be set in a manner that ensures 11 that the entire biennial appropriation for the quality incentive 12 program is allocated. 13 (h) Facilities with insufficient three-quarter average centers 14 for medicare and medicaid services quality data must be assigned to 15 the tier corresponding to their five-star quality rating. Facilities 16 with a five-star quality rating must be assigned to the highest tier 17 (tier V) and facilities with a one-star quality rating must be 18 assigned to the lowest tier (tier I). The use of a facility's five- 19 star quality rating shall only occur in the case of insufficient 20 centers for medicare and medicaid services minimum data set 21 information. 22 (i) The quality incentive rates must be adjusted semiannually on 23 July 1 and January 1 of each year using, at a minimum, the most 24 recent available three-quarter average centers for medicare and 25 medicaid services quality data. 26 (j) Beginning July 1, 2017, the percentage of short-stay 27 residents who newly received an antipsychotic medication must be 28 added as a quality measure. The department must determine the quality 29 incentive thresholds for this quality measure in a manner consistent 30 with those outlined in (b) through (h) of this subsection using the 31 centers for medicare and medicaid services quality data. 32 (k) Beginning July 1, 2017, the percentage of direct care staff 33 turnover must be added as a quality measure using the centers for 34 medicare and medicaid services' payroll-based journal and nursing 35 home facility payroll data. Turnover is defined as an employee 36 departure. The department must determine the quality incentive 37 thresholds for this quality measure using data from the centers for 38 medicare and medicaid services' payroll-based journal, unless such 39 data is not available, in which case the department shall use direct 40 p. 703 ESSB 5187.SL