What the NFQIP is
The Nursing Facility Quality Incentive Program is Pennsylvania's quality payment for Medical Assistance nursing facilities. The Department of Human Services writes it into its contract with the Community HealthChoices managed care plans, as Exhibit DD(2), and directs the plans to pay it. CMS approved it for each year from 2022 through 2025, and on April 23, 2026 approved calendar 2026 at up to $15 million.
There is no downside. A building that scores nothing is paid nothing, but nothing is taken away.
How the 24 points are built
| Measure | Source |
|---|---|
| Short-stay residents rehospitalized | Claims |
| Pressure ulcers (long-stay) | MDS |
| Falls with major injury (long-stay) | MDS |
| Influenza vaccine (long-stay) | MDS |
| Pneumococcal vaccine (long-stay) | MDS |
| Antipsychotic medication (long-stay) | MDS, and claims since January 2026 |
Benchmarks: up to 12 points
On each measure, a building at or better than the median of Pennsylvania Medicaid facilities earns 1 point. At the best quartile (the 75th percentile where higher is better, the 25th where lower is better) it earns a second.
Improvement: up to 12 points
| Improvement on last year | Points |
|---|---|
| 2.0 percentage points or more | 2 |
| 1.0 to 1.99 | 1 |
| 0.5 to 0.99 | 0.5 |
| Under 0.5 | 0 |
For 2026 there are no improvement points for antipsychotics. CMS re-specified that measure in January 2026 to read claims as well as the MDS, and DHS says the 2026 data may not be comparable with last year's.
Two things to qualify at all. A building has to reach the median, or improve by at least 0.5, on at least one of the six measures. And someone from the building has to attend at least one live Long-Term Care Learning Network webinar hosted by the Jewish Healthcare Foundation during 2026. DHS checks attendance and drops buildings that didn't.
How points become dollars
Each building's points are multiplied by its CHC Medical Assistance occupancy: its CHC MA days in 2026 divided by all its days of care. DHS divides the $15 million by the total of those adjusted points statewide to set the value of a point, and each building is paid its adjusted points times that value, split across the plans it served.
So a point's value isn't known in advance. It falls when more buildings earn points, and a building with more CHC residents gets more for the same score.
See your building’s Pennsylvania measures against the nation.
When your work shows up
The 2026 program compares calendar 2026 with calendar 2025, using CMS's four-quarter averages for the MDS measures and the adjusted score for rehospitalizations. Payments are made after the year ends and CMS has published the data. The contract has DHS tell the plans the program's maximum payout by November 30, 2027.
Every quarter of 2026 is in the average, and the last one is open now. Improvement is the half of the score you can still move this year.
What SuperQM covers in Pennsylvania
Five of the six measures come from the MDS, and SuperQM computes them from your own charting for the year you're in, against your 2025 rate, so you can see which are closest to the next half point. For antipsychotics, SuperQM computes the MDS side; the claims side shows up only in what CMS publishes.
Rehospitalization comes from Medicare claims, so SuperQM shows the figure CMS publishes. DHS doesn't publish its benchmark percentiles ahead of time, so SuperQM shows where you stand against last year and the nation, not a promised benchmark point. See how SuperQM works.
