The Pay-For-Performance (P4P) program awards facilities who perform highly on certain quality indicators. A total amount of one percent of the Program's nursing facility budget is awarded each year. Eligible facilities receiving the highest scores receive 85 percent of this total; facilities that did not qualify based on the highest ranked scores, but whose scores had improved from the previous year, receive 15 percent of the total.

Nursing facilities participating in Medicaid are potentially eligible for a P4P awards if they:

• Have 45 or more beds;
• Are not continuing care retirement centers (CCRCs); and
• In the previous year ending March 31, have not experienced any of the following:
• Been identified as a federally-designated “special focus facility" 
• Had a denial  of payment for new admissions (DPNA) by CMS, or
• Being determined to have provided “substandard quality of care" as defined in federal Medicaid regulations

Performance is based on the following information:

• Staffing Level (maximum 20 points)
• Uses data for the nine-month period ending March 31
• Optimum/target staffing levels: 4.13 for NFs with average acuity, adjusted on NF-specific basis depending on overall RUG category
• If actual staffing exceeds optimal/target staffing, facility receives 20 points
• If actual staffing is less than optimal/target staffing, facility receives 0-19 points
• Staff Stability (maximum 15 points)
• Measures percentage of staff
• Uses NF-reported data from Staffing Stability Survey, based on payroll information during the pay period that includes March 31
• Points awarded based on percentage of staff who have worked at the NF for more than 2 years
• MDS Quality Indicators (Long Stay) - 30 points maximum
• Based on MDS data for the three-month period ending December 31
• 5 points awarded for each of the following:
• % of long stay residents with falls resulting in major injury
• % of high-risk residents with pressure sores
• % of residents with catheters
• % of residents with urinary tract infection
• % of long stay residents receiving the influenza vaccine
•  % of long stay residents receiving the pneumococcal  vaccine
• Maryland Health Care Commission's Family Satisfaction Survey (Completed annually, usually in the autumn) - 30 points maximum
• Up to 6 points may be awarded for each of the following categories:
• Overall Care
• Recommend the nursing facility
• Up to 3 points may be awarded for each of the following:
• Staff and Administration
• Care provided to residents
• Food and meals
• Autonomy and resident rights
  
• Physical aspects of the nursing facility
• Activities
• Staff Immunizations - 5 points maximum
  
• A minimum of 90% of staff must be immunized to qualify for the award
  
• Points are awarded as follows:
  
• At least 90% but less than 95% - 2 points
• 95% or greater - 5 points 

For help reviewing your scoresheet, please see our Scoresheet Guide​.

Congratulations to Maryland's FY2025 P4P Winners!

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View the full list for FY 2025​​​.