Nursing Facility Quality Incentives and Accountability Act

This Act creates a voluntary quality incentive program for nursing facilities participating in Medicare and Medicaid. The Secretary of Health and Human Services, through CMS, will set performance metrics based on existing data, including minimum staffing hours per resident day (adjusted for acuity), infection control, and resident satisfaction scores from CMS star ratings. Facilities meeting 80% or more of metrics receive bonus payments up to 3% of annual Medicare/Medicaid reimbursements; underperformers face public reporting but no payment cuts beyond current law. CMS will award competitive grants to states for nursing workforce recruitment, training, and retention programs, prioritizing rural and high-need areas. States must match 10% of grants and report outcomes annually. No new mandates on facilities or states; participation is optional via funding acceptance. All facilities must submit transparent quarterly data on staffing, incidents, and outcomes to a public CMS dashboard. CMS will conduct risk-based surveys, increasing frequency for low performers. The program promotes best practices without overriding state licensing. Improvements tighten focus on measurable outcomes, control costs via incentives over mandates, and sunset to allow evaluation.