What the Kentucky Quality Program is
Starting with July 1, 2025 rates, Kentucky's Medicaid nursing facility per diem includes a quality add-on. The Department for Medicaid Services wrote it into the state plan in SPA KY 25-0004, which CMS approved in August 2025, and into regulation at 907 KAR 1:065, Section 13. It is recalculated every quarter, with the rest of the case-mix rate.
It isn't new money. The pool comes out of the per-day allowance that offsets the provider assessment. That allowance was $41.43 a day. It drops in steps to $35.07 in January 2027, and the difference is paid back by score. Funds left unspent roll into the next state fiscal year's pool.
How the 700 points are scored
Seven metrics, weighted equally, 100 points each. Four are CMS long-stay quality measures read from Care Compare. Two come from the building's Medicaid supplemental schedule (NF-7). One is a behavioral-health attestation.
| Metric | Source | Points |
|---|---|---|
| Urinary tract infection (long-stay) | Care Compare | 100 |
| Falls with major injury (long-stay) | Care Compare | 100 |
| Pressure ulcers (long-stay) | Care Compare | 100 |
| Antipsychotic medication (long-stay) | Care Compare | 100 |
| Occupancy | NF-7 schedule | 100 |
| Medicaid utilization | NF-7 schedule | 100 |
| Center of Excellence participation | Attestation | 100 |
The quality measure tiers
Each measure has five tiers, worth 20, 40, 60, 80 and 100 points. The state plan takes the tier lines from the CMS Five-Star Technical Users' Guide. For UTI, falls and pressure ulcers those are the Five-Star quintiles, and lower is better:
| Measure | 100 | 80 | 60 | 40 | 20 |
|---|---|---|---|---|---|
| UTI | ≤ 0.70% | ≤ 1.60% | ≤ 2.72% | ≤ 4.52% | above |
| Falls with major injury | ≤ 1.34% | ≤ 2.46% | ≤ 3.56% | ≤ 5.14% | above |
| Pressure ulcers | ≤ 2.88% | ≤ 4.45% | ≤ 5.97% | ≤ 7.97% | above |
Those are the lines in the July 2026 guide. Five-Star scores antipsychotic use in ten deciles, not five; the contractor's 2025 draft scorecard used every second decile line as a Kentucky tier. How Five-Star points each measure.
The other three
Occupancy and Medicaid utilization each have five tiers, at 25%, 60%, 80%, 90% and 95%. The behavioral-health metric has four progressive tiers, 25 points each, built on the Center of Excellence for Behavioral Health in Nursing Facilities. A building attests to each tier and uploads its evidence to Myers and Stauffer. Each tier expires a year after it was completed.
What it pays
The pool is set per Medicaid day, and grows in four steps:
| Rates effective | Pool per Medicaid day | Allowance left |
|---|---|---|
| Jul–Dec 2025 | $1.59 | $39.84 |
| Jan–Jun 2026 | $3.18 | $38.25 |
| Jul–Dec 2026 | $4.77 | $36.66 |
| From Jan 2027 | $6.36 | $35.07 |
Your points divided by 700, times your Medicaid days, are your Quality Adjusted Medicaid Days. Your share of the statewide total of those days is your share of the pool. Spread over your Medicaid days, it becomes a per-day add-on in your rate.
So what you're paid depends on everyone else. Our arithmetic: a building scoring at the statewide average gets back roughly the amount its allowance was cut. Score above average and you get back more; below, less. In the contractor's worked example, a building scoring 445 of 700, on an $8 million annual pool, was paid $1.73 a Medicaid day.
What SuperQM covers
The four long-stay measures: 400 of the 700 points, or 57%. SuperQM computes them per resident, live, for the quarter you're in, from your EHR. It shows each measure against the Kentucky tier lines, names the residents behind it, says when each one clears, and sends the fix to the MDS coordinator. Long-stay antipsychotic use has blended Medicare claims with the MDS since January 2026, so SuperQM shows the MDS half of that rate.
It does not compute occupancy or Medicaid utilization. Those are census and payer-mix numbers from your NF-7 schedule, and together they are 200 points, or 29%. It doesn't handle the behavioral-health attestation either, the other 100.
See your building’s four Kentucky measures against the nation.
When your work shows up
Kentucky sets rates each January, April, July and October. The add-on uses the most recent information as of the day before the rate takes effect. For the four measures, that is whatever Care Compare shows that day.
Care Compare averages four quarters of care that ended months earlier, so a resident who clears today moves the published rate a quarter at a time. How the refreshes work.
Attestations are due by June 30 for July rates, September 30 for October, December 31 for January and March 31 for April. Anything late waits for the next quarter.
