What Washington’s quality enhancement is
Washington pays every Medicaid nursing home a daily rate built from components, and one of them is a quality incentive. RCW 74.46.561 has required it since July 1, 2016: a rate enhancement of no less than 1% and no more than 5% of the statewide average daily rate, paid to buildings that meet the standard. The Department of Social and Health Services calls it the quality enhancement, or QE, and publishes each building's calculation with the rates.
The whole appropriation is paid out. The statute says tier payments must be set so the entire biennial appropriation is allocated, and the September 2026 statewide weighted average for QE was $3.66 per Medicaid day across 183 homes.
How the 125 points are built
Each measure earns 25, 20, 15 or 0 points against fixed lines. DSHS takes the lines from the CMS Five-Star guide, not from how other Washington homes did, so every building can reach the top at once. The July 1, 2026 lines, on a four-quarter average:
| Measure | 25 points | 20 | 15 |
|---|---|---|---|
| UTI (long-stay) | 0.7% or less | 1.6% | 2.72% |
| Pressure ulcers (long-stay) | 2.88% or less | 4.45% | 5.97% |
| Falls with major injury (long-stay) | 1.34% or less | 2.46% | 3.56% |
| New antipsychotic (short-stay) | 0% | 0.96% | 1.68% |
| Direct care staff turnover | 24.00% or less | 34.43% | 41.80% |
Above the last line, a measure scores zero. Turnover is scored differently from the other four: DSHS takes it from each home's Medicaid cost report and cuts it at the statewide quartiles. The pain measure that older summaries list was discontinued in October 2019.
The short-stay antipsychotic measure is the unusual one. It counts short-stay residents who start an antipsychotic during the stay, and the top 25 points need a rate of exactly zero.
What each tier pays
| Tier | Points (of 125) | Per Medicaid day, July 2026 | Homes, July 2026 |
|---|---|---|---|
| V | 100 and up | $7.96 | 39 |
| IV | 87.5 and up | $5.97 | 23 |
| III | 75 and up | $3.98 | 41 |
| II | 62.5 and up | $1.99 | 33 |
| I | under 62.5 | Nothing | 47 |
The tiers are fixed shares of tier V: 75%, 50% and 25%. Every step is worth $1.99 on every Medicaid day at July 2026 rates, about $36,000 a year for a home with 18,250 Medicaid days. Points move in fives, so one measure moving one line can cross a tier.
A home without enough CMS quality data is placed by its Five-Star quality rating instead: 5 stars is tier V and 1 star is tier I.
See your building’s Washington measures against the nation.
When your work shows up
The statute resets the quality rates twice a year, on July 1 and January 1, from the latest CMS data. The July 1, 2026 rates read the four quarters of 2025, from CMS data processed May 1, 2026, and turnover from the 2025 cost reports.
So care in a quarter reaches the rate only after CMS publishes it, and then it sits in the four-quarter average for a year of CMS data. The time to move a measure is while the quarter is still open.
What SuperQM covers in Washington
The four quality measures are MDS measures, and SuperQM computes all four from your own charting, for the quarter you're in, against Washington's lines. That is 100 of the 125 points. It shows the points and the tier they add up to, and which resident is the difference.
Turnover, the other 25 points, comes from your Medicaid cost report. SuperQM doesn't forecast it. It shows your published PBJ staffing figures, which run about two quarters behind. Without turnover points, a home needs the top line on all four quality measures to reach tier V. See how SuperQM works.
