What West Virginia’s quality component is
When West Virginia moved its Medicaid nursing facility rate to PDPM on October 1, 2024, it added a quality component to every building's per diem. CMS approved it as state plan amendment 24-0004 in August 2025, and the Bureau for Medical Services' Chapter 514 manual, updated for July 2026, carries it unchanged.
The pool started at $60 million a year and grows each year with the CMS skilled nursing market basket. 90% of it is paid on a quality score out of 100. The other 10% is a Special Populations add-on for Medicaid residents coded with behavioral symptoms (E0200A–C), rejection of care (E0800) or wandering (E0900) on the MDS.
The four measures and the cut points
BMS scores four long-stay measures, each worth up to 25 points, from CMS's Care Compare data. Each building's rate is compared to fixed cut points: at or under a cut point earns that tier. These are the cut points in BMS's policy file effective July 1, 2026:
| Measure | 25 pts | 20 pts | 15 pts | 10 pts |
|---|---|---|---|---|
| Urinary tract infection | 1.64% | 2.77% | 5.00% | 7.00% |
| Catheter inserted and left in the bladder | 0.33% | 0.88% | 2.00% | 4.51% |
| Antipsychotic medication | 9.00% | 13.01% | 20.03% | 28.03% |
| Depressive symptoms | 0.00% | 1.50% | 5.00% | 13.50% |
Worse than the 10-point line still earns 5 points, so every building scores between 20 and 100. A building missing from the Care Compare data on a measure is put in the middle tier, 15 points.
BMS set the first cut points from statewide results in the first half of 2023 and can change them between rate periods. It did once: the antipsychotic lines moved up for July 2026. Nurse staffing hours and high-risk pressure ulcers are on the scorecard for information only, and BMS says they may be scored in future.
How the score becomes a per diem
There are no fixed dollars per tier. Each building's Medicaid days are multiplied by its score out of 100, and the quality pool is split in proportion to those quality-adjusted days. BMS divides each building's share by its annualized Medicaid days and pays it as a per diem in the rate for the next six months.
So what matters is your score against everyone else's. A building that goes from 75 to 80 points gets about 6.6% more of the pool if nothing else changes, and one that stands still loses ground when other buildings improve. There is no floor and no minimum score to be paid.
When your work shows up
BMS rescores every building twice a year. The July rate uses CMS's April Care Compare release and the January rate uses October's. Each release averages four quarters of MDS data ending two quarters before it comes out, so the April 2027 release covers calendar 2026.
That means care in the quarter you're in now reaches the July 2027 rate, and stays in the January 2028 rate too: a year of per diems from one quarter of assessments. The PDPM phase-in ends the same July, when rates move fully to the PDPM calculation.
See your building’s UTI, catheter, antipsychotic and depression rates against the nation.
What moves the score
- UTIs only when they meet the definition. I2300 needs both the evidence-based criteria and a physician diagnosis in the 30-day look-back. A positive culture alone isn't a UTI.
- Code the catheter exclusions that are real. The long-stay catheter measure leaves out residents with active neurogenic bladder or obstructive uropathy. When a physician has diagnosed one and it is active, it belongs on the MDS.
- Depression is scored from zero. The full 25 points needs a 0.00% rate, and 1.50% is the 20-point line. One resident can be a whole tier. Interview in the look-back and code the PHQ exactly as answered.
- Antipsychotics reach claims now. Since January 2026 CMS also reads Medicare and Medicaid claims for the long-stay antipsychotic measure, so a stopped drug can stay in it longer than the 7-day look-back suggests.
What SuperQM covers
All four scored measures are MDS quality measures, so SuperQM covers the whole 100-point score. It computes each one per resident, live, for the quarter you're in, from your EHR, shows it against BMS's tiers, names the residents in the numerator, says when each one clears, and sends the fix to the MDS coordinator. For antipsychotics it sees the MDS half of the measure; the claims half shows up only in CMS's published figure.
The Special Populations add-on is paid on MDS coding too, but it rewards serving residents with behavioral needs, not a score to improve. See how SuperQM works.
