What QuILTSS is
QuILTSS, Quality Improvement in Long-Term Services and Supports, is how TennCare builds quality into every Medicaid nursing facility rate. Under TennCare Rule 1200-13-02-.11, part of the nursing facility budget is set aside each year for a quality-based component of the per diem: at launch, at least $40 million or 4% of projected spending, rising at twice the rate of inflation until it reaches 10%.
Each building is scored on a calendar year, and the score sets the quality component and the quality tier in the rate from the next July 1. TennCare works with Myers and Stauffer on rate setting and with QBlue on the surveys.
The 110 points
QuILTSS #19, scoring calendar 2026 for the rates from July 1, 2027, is the first period on a new measure set. TennCare wrote it into the rule in June 2026.
| Domain | Measures | Points |
|---|---|---|
| Satisfaction | Resident 15, family 10, employee 10 | 35 |
| Culture change and quality of life | Respectful treatment 10, resident choice 10, resident and family input 5, meaningful activities 5 | 30 |
| Staffing and staff competency | Licensed nurse hours, aide hours, consistent assignment, retention, 5 each | 20 |
| Clinical performance (MDS) | Catheter, pressure ulcers, weight loss, 5 each | 15 |
| Quality initiative bonus | Eden Alternative, Baldrige or AHCA/NCAL award, CARF, Joint Commission; all or nothing | 10 |
The rates in effect now, July 2026 to June 2027, come from QuILTSS #18 and the old set: 10 clinical points for long-stay antipsychotics and UTIs, and 25 staffing points including staff training. #19 retires all three.
How the clinical points are scored
The catheter, pressure ulcer and weight loss measures are read from CMS's January refresh: four quarters, usually Q4 of the prior year through Q3. Each quarter is scored on its own against the national average for that quarter:
| The quarter's rate | Points |
|---|---|
| Below the national average | 5 |
| Not below, but fell faster than the national trend | 3 |
| Neither | 0 |
The quarters are then weighted 50% for the most recent, 25%, 15% and 10%. If the most recent quarter isn't the best, TennCare also weights all four equally and keeps the better result. So the last quarter of the window, July to September, is worth half of each measure.
What a tier changes
The score does two things. It sets the building's quality-based component, by its Medicaid days and the share of the points it earned. And it places the building in a tier, which changes three other parts of the rate:
| Tier 1 (75+) | Tier 2 (50–74.99) | Tier 3 (under 50) | |
|---|---|---|---|
| Direct care, non-case-mix price multiplier | 105% | 102.5% | 100% |
| Direct care spending floor | 90% | 92% | 94% |
| Fair rental value rental factor | 8.70% | 8.35% | 8.00% |
Missing data is Tier 3. A building that doesn't submit complete, accurate and timely quality data is placed in Tier 3 and gets no quality incentive payment. One more than 30 days late on the nursing facility assessment fee has the quality component suspended until it pays.
See your building’s catheter, pressure ulcer and weight loss rates against the nation.
What SuperQM covers, honestly
The MDS measures are 15 of the 110 points from July 2027, about 14%, and 10 of 110 in the rates paid now. SuperQM scores catheter, pressure ulcers and weight loss from your own charting, quarter by quarter, and names the residents in each. Those are the points a building can still move with care and coding inside the quarter.
The other 95 points are surveys, culture-change measures, staffing and a bonus. SuperQM shows CMS's published staffing scorecard, about two quarters behind, not a live forecast. It doesn't run the QBlue surveys, the consistent assignment or retention reports, or the bonus applications. See how SuperQM works.
When your work shows up
QuILTSS #19's clinical window is expected to be Q4 2025 through Q3 2026, the quarter that ends September 30, 2026, which TennCare reads from CMS in January 2027 for the rates from July 1, 2027. If the pattern holds, the quarter that starts October 1, 2026 opens #20's window, for the rates from July 2028.
The rule keeps a measure set for at least three years once it changes, so catheter, pressure ulcers and weight loss are the clinical measures for the July 2027 rates and the two years after.
