The Molina Quality Living
A Program Summary
Molina Healthcare of Texas is offering the Molina Quality Living Program (MQL Program) to reward quality and efficiency for Nursing Facilities (NFs) that meet or exceed specific performance criteria in the provision of residential/custodial nursing facility care to Molina members. Based on the level of quality provided to Texas residents, Molina will invite Nursing Facilities to participate and benefit from the program features offered by Molina Healthcare of Texas. Please Note - Providers are prohibited from influencing MCO selection.
| PLATINUM Facility | GOLD Facility | SILVER Facility | |
| Recognition Criteria | |||
| Demonstrated Quality | Achieved 5 out of 5 STARS Overall with 4 or 5 STARS for Quality Measures | Achieved 4 out of 5 STARS Overall with 4 or 5 STARS for Quality Measures | Achieved 3 out of 5 STARS Overall with 4 or 5 STARS for Quality Measure |
|
STAR Ratings are from the reporting on the CMS Nursing Home Compare website, as calculated by CMS. |
|||
| Program Features | |||
| Pay-for-Quality | $10 Per Resident Per Month for EACH measure achieved of the 7 quality measures | $8 Per Resident Per Month for EACH measure achieved of the 7 quality measures | $5 Per Resident Per Month for EACH measure achieved of the 7 quality measures |
| Recognition | Molina will provide a posting for the NF to use on their social media identifying their level of achievement in the MQL program. | Molina will provide a posting for the NF to use on their social media identifying their level of achievement in the MQL program. | Molina will provide a posting for the NF to use on their social media identifying their level of achievement in the MQL program. |
| Molina Sponsored Employee Appreciation Activities | One activity for each 2 consecutive quarters periods of qualifying for MQL | One activity for each 3 consecutive quarters periods of qualifying for MQL | One activity for each 4 consecutive quarters of qualifying for MQL |
| Exclusive MQL Events |
Invitations to attend off-site special events designed for residents of MQL qualified facilities |
||
| MQL Advance Payment (Shared Risk Arrangement) | Each qualifying MQL facility will be paid in advance $30 per member per month in anticipation of earning the pay-for-quality funds based upon average membership in the preceding quarter. A NF must have at least 1 member per month in the previous quarter and achieved a minimium of 3 quality measures to be qualified to participate in the Advance Payment program. Reconciliation of funds will be quarterly. | ||
Molina Quality Living Pay-For-Quality (P4Q) Program
As a Molina Quality Living Program participant at the Platinum, Gold or Silver level, Molina will offer a P4Q program where Molina Quality Living providers will be eligible to receive up to an additional $70 Per Resident Per Month for meeting or exceeding quality and performance measure thresholds in various categories.
Quality Measures – Nursing Facilities will be scored on quality measures as reported on the CMS Nursing Home Compare website. If the NF meets or exceeds the National Average score AND the Texas Average score, the NF will earn additional payment of additional payment of $5/$8/$10 Per Resident Per Month based upon their Overall and Quality Measure STARS as reported on CMS Nursing Home Compare and defined as Platinum, Gold or Silver level of recognition.
| Quality Measures | Standard | Additional Payment |
| % of Long-stay High-Risk Residents with pressure ulcers | Meet or exceed the National Average score AND the Texas Average score | $5/$8/$10 PRMP |
| % of Long-stay Residents who received antipsychotic medication | $5/$8/$10 PRMP | |
| % of Long-stay Residents whose need for help with daily activities has increased | $5/$8/$10 PRMP | |
| % of Long-stay Residents assessed and given, appropriately, the pneumococcal vaccination | $5/$8/$10 PRMP | |
| % of Long-stay Residents accessed and given, appropriately, the seasonal influenza vaccine | $5/$8/$10 PRMP | |
| Number of hospitalizations per 1000 long-stay resident days | Meet or exceed the National Meet or exceed the National Average score AND the Texas Average score | $5/$8/$10 PRMP |
| Number of outpatient emergency department visits per 1000 long-stay resident days | Meet or exceed the National Meet or exceed the National Average score AND the Texas Average score | $5/$8/$10 PRMP |
| TOTAL Additional Payment Opportunity | Paid Quarterly on a Per Resident Per Month Basis | Up to $70.00 PRPM |