What Colorado’s P4P is
The Nursing Facility Pay-for-Performance program has run since July 2009 under 10 CCR 2505-10 §8.443.12. The Department of Health Care Policy and Financing pays a supplemental per diem to Class I nursing facilities, set by a 100-point application scored once a year. Applying is voluntary, and almost everyone does: 175 of 182 homes applied for program year 2026.
Since July 2024 the money is tied to the provider fee. Total P4P payments must be at least 12% of all provider-fee supplemental payments in SFY 2024-25 and 2025-26, and at least 15% from SFY 2026-27 on.
How the 100 points are built
It is an application, not a calculation from CMS data. The 2027 application, which scores calendar 2026, has two domains:
| Part | Points |
|---|---|
| Quality of life: dining, personal care, trauma-informed care, consistent assignments, equity and more | 52 |
| Quality measures from CASPER, best five of eight | 20 |
| UTI and catheter measures, 1 point each | 2 |
| Staff retention, DON and administrator retention, nursing turnover | 8 |
| Other quality of care: QM narrative, vaccine education, hospitalizations, best practices, infection control, behavioral health | 18 |
| Total | 100 |
Every measure has minimum requirements and needs documents to prove them. There are no partial points, and some homes get an on-site visit: 18 were chosen for the 2026 review.
The quality measure points
Each home enters its CASPER facility-adjusted rates for Q3 and Q4 of the year on eight long-stay measures. The two quarters are averaged and compared with the same average for every Colorado home on Care Compare. A measure earns 4 points at the 25th percentile or better, 3 at the 30th, 2 at the 40th and 1 at the state median. Worse than the median earns nothing. Only the five best of the eight count.
- High-risk pressure ulcers
- Falls with major injury
- Antipsychotic medication
- Depressive symptoms
- Low-risk residents who lose bowel or bladder control
- Losing too much weight
- Need for help with daily activities increased
- Ability to move independently worsened
Two more points sit in the infection control measure: 1 each for UTI and catheter rates, if your Q3–Q4 average beats the state's or your own from the year before.
What each tier pays
Your final score sets a per diem, paid on every Medicaid day. These are the rates for program year 2026, paid in SFY 2026-27:
| Points | Per Medicaid day |
|---|---|
| 80–100 | $7.28 |
| 61–79 | $5.46 |
| 46–60 | $3.64 |
| 21–45 | $1.82 |
| 0–20 | Nothing |
Crossing 80 is worth $1.82 on every Medicaid day, about $36,000 a year for a home with 20,000 Medicaid days. The payment is split into twelve monthly amounts.
A substandard deficiency halves it. A home with a substandard quality of care deficiency on any state survey in the year gets half its calculated payment. 21 homes did in 2025. And every applicant must run a yearly resident and family satisfaction survey, designed and tabulated by an outside party, or it can't apply.
When your work shows up
The 2027 application covers calendar 2026 and is due February 28, 2027. Its quality measure points come only from Q3 (July to September) and Q4 (October to December) of 2026. Myers & Stauffer reviews the applications for the state; its review of the 2026 applications came out in June 2026.
So the quality measure window for the 2027 application is open right now, and closes December 31. The first half of the year doesn't count toward those points at all.
See your building’s eight Colorado P4P measures against the nation.
What SuperQM covers
SuperQM computes all eight quality measures, plus UTI and catheter, per resident, live, for the quarter you're in, from your EHR. It shows each rate against Colorado's percentile bands, names the residents in each numerator, says when each one clears, and sends the fix to the MDS coordinator. That is 22 of the 100 points. For antipsychotics it sees the MDS half of the measure; since January 2026 CMS also reads claims.
The other 78 points are narratives, programs, training records, and retention and turnover worked out from your own payroll. SuperQM doesn't write or score those, and it doesn't run satisfaction surveys. Colorado's application is mostly paperwork; SuperQM takes care of the part that moves on your residents' assessments. See how SuperQM works.
