What Maryland’s P4P is
Maryland Medicaid pays a share of its nursing facility budget on quality. Under COMAR 10.09.10.19, 1% of the budget allocation for nursing facility services is paid out each year on pay-for-performance scores, as it has been since state fiscal year 2021. The Maryland Department of Health scores every eligible building out of 100 and pays the top of the field.
To be eligible, a building needs 45 or more beds, can't be a continuing care retirement community, and, in the year ending March 31, can't have been a Special Focus Facility, denied payment for new admissions, found to give substandard quality of care, or behind on the quality assessment. In FY 2026, 153 of 204 participating buildings were eligible.
How the 100 points are built
| Part | Points | Data |
|---|---|---|
| Staffing level against an acuity-based goal | 20 | Payroll-Based Journal, 9 months to March 31 |
| Staff stability: nursing staff here 2+ years | 15 | Facility report, pay period with March 31 |
| MHCC Nursing Facility Family Survey | 30 | The most recent survey |
| Six long-stay MDS indicators, 5 each | 30 | Three months ending December 31 |
| Staff flu vaccination | 5 | 2 points at 90%, 5 at 95% |
The six MDS indicators, as COMAR 10.09.10.15 names them:
- High-risk residents with pressure sores
- Falls with major injury
- A catheter inserted and left in the bladder
- Urinary tract infection
- Influenza vaccine and pneumococcal vaccine
Every part but staff flu is scored against the other buildings, not a fixed line. The best score in the state gets full points, the median weighted by days of care gets half, and a building as far below the median as the best is above it gets none. In the FY 2026 file, a building with no UTIs in the quarter got all 5 UTI points, and one at about 1.7% got about 2. The regulation still names CMS's older high-risk pressure ulcer measure, which CMS has since replaced with one that counts every long-stay resident.
How the money is split
MDH ranks the eligible buildings by total score. 85% of the pool goes to the highest scorers that together hold 40% of eligible days of care, and the top scorer gets twice the per-day amount of the lowest one paid. The other 15% goes to buildings that improved most on last year and weren't already paid for performance. Each award is a lump sum: the per-day amount times the building's Medicaid days from its most recent cost report.
For FY 2026, 58 buildings were paid for performance, from $6.27 to $12.54 per Medicaid day, $13,712,880 in all. 44 were paid for improvement, from $1.45 to $2.91 a day, $2,419,920 in all. The last building paid for performance scored 55.2.
See your building’s long-stay measures against the nation.
What SuperQM covers, honestly
The six MDS indicators are 30 of the 100 points. SuperQM scores all six from your own charting, live, for the October to December quarter Maryland reads, and names the residents behind each one. Because the other buildings set the scale, SuperQM can show your rate and who is in it, but not the exact points until MDH publishes the field.
Staffing is 20 points from the Payroll-Based Journal; SuperQM shows CMS's published staffing scorecard, about two quarters behind, not a live forecast. Staff stability (15), the MHCC family survey (30) and staff flu vaccination (5) come from reports and surveys SuperQM doesn't run. See how SuperQM works.
Why one quarter matters so much
Most state programs average a year of MDS data. Maryland reads one quarter, the three months ending December 31, so a single resident in October, November or December moves a whole indicator. The next quarter Maryland will read opens October 1, 2026.
COMAR has MDH report scores around July 1, with 30 days to review and comment. The FY 2026 file was posted in September 2025; the FY 2027 file isn't posted yet.
