January, 2020 – Northern Mahaska Specialty Care has earned the American Healthcare Association’s (AHCA) 2020 Quality Initiative Tier 4 Recognition. January, 2020 – New London Specialty Care has earned the American Health Care Association’s (AHCA) 2020 Quality Initiative Tier 4 Recognition. Only 66 skilled nursing facilities out Iowa’s 439 achieved this level. Skilled nursing facilities that have achieved four out of four of the established quality initiatives dedicated their efforts over the past year to achieve the following improvements: