What Oklahoma PFP is
Pay-for-Performance is the quality part of Oklahoma's Medicaid nursing facility rate. It began on October 1, 2019, replacing the older Focus on Excellence program, under 56 O.S. 1011.5. The Oklahoma Health Care Authority runs it under OAC 317:30-5-136.1. Any nursing facility licensed and certified by the Oklahoma State Department of Health can take part. OHCA counted 279 long-term care facilities in the program at the end of 2024.
It pays on four CMS long-stay quality measures, each worth the same, and only those four. There is no staffing score, no survey score and no application. OHCA's June 2026 rate brief keeps the PFP component in the SFY 2027 rate, at an average of $5.00 per patient day, with no change in method.
How a measure is met
| Measure (long-stay) | Read more |
|---|---|
| Pressure ulcers | N045 |
| Residents who lose too much weight | K0300 |
| Antipsychotic medication | Antipsychotics |
| Urinary tract infection | The 30-day look-back |
Each quarter, each measure is pass or fail, and there are two ways to pass: beat your own improvement target, or be at or better than the CMS national average. OHCA takes the rate from the building's own CASPER facility-level quality measure report.
The improvement target climbs
OHCA sets each building's baseline once a year, from the latest four quarters CMS has, and holds it from October 1 to September 30. The target is 5% below that baseline in the first quarter, then 10%, 15% and 20%. OHCA's own example: a 12.75% baseline gives targets of 12.11%, 11.48%, 10.84% and 10.20%. Holding last quarter's gain isn't enough, and a small improvement that misses the target pays nothing.
The rule still calls the first measure “high risk/unstageable pressure ulcers”. CMS retired that measure, and OHCA's program page now lists CMS's replacement long-stay pressure ulcer measure.
What it pays, and what takes it away
Each measure met is worth at least $1.25 per Medicaid patient day for the quarter, so all four are worth at least $5.00 a day. A building with 6,250 Medicaid days in a quarter earns at least $7,800 for each measure it meets. OHCA pays it as a lump sum after the quarter, not on the daily rate.
One survey can cost the quarter. Under the rule, a deficiency at scope and severity “I” or higher from the Oklahoma State Department of Health forfeits the PFP incentive for the quarter out of compliance. OHCA's training ties the loss to deficiencies related to a program measure, and says it lasts until the building is back in compliance.
OHCA also audits. Buildings picked for a desk or on-site review have 15 business days to send the documents asked for, usually the QAPI plan, the performance improvement project and the CASPER report, or the payment is withheld. There is no exception for small buildings, where one resident can decide a measure.
See your building’s four Oklahoma measures against the nation.
When your work shows up
| Care in | Submit by | Paid in |
|---|---|---|
| October to December | January 30 | February |
| January to March | April 30 | May |
| April to June | July 30 | August |
| July to September | October 30 | November |
Care in a quarter is paid about two months after it ends. That also means the only time to change a quarter is during it: once the 30-day window closes, OHCA doesn't accept corrections.
How SuperQM helps Oklahoma buildings
All four PFP measures are MDS measures, and SuperQM computes every one of them from your own charting, for the quarter you're in: against your improvement target and against the national average, so you know which of the two a measure is closer to. That covers the whole PFP score.
When a resident is about to tip a measure over its target, or a code doesn't match the chart, the right person hears about it that day, while the quarter can still change. See how SuperQM works.
