MedicaidReimbursementLow impact
Fiscal Year 2025 Nursing Facility Pay-for Performance Scores
Maryland Medicaid·MD · Geriatrics, Palliative Care·Nursing Home
Effective date
Oct 27, 2025
We identified it
Jun 20, 2026
Summary
Maryland updated its Fiscal Year 2025 Nursing Facility Pay-for-Performance (P4P) program, which distributes approximately $16.1 million in quality incentive payments to high-performing nursing facilities based on five quality measures. Eligible facilities (40% highest scorers) receive $6.27-$12.54 per Medicaid patient day, while facilities with improved scores receive $1.45-$2.91 per patient day through the Pay-for-Improvement (P4I) program. Nursing facilities must review their individual P4P results and scores within 30 days of October 27, 2025.
Action Required
By November 26, 2025: Nursing facility administrators and billing teams should review the P4P/P4I enclosure received with this transmittal to confirm facility eligibility status, quality measure scores, and projected award amounts. Verify that the facility is not excluded due to special focus facility designation, payment denial for new admissions, or substandard quality of care findings. If significant errors in P4P score calculations are identified, submit documented corrections within the initial 30-day review period. Finance teams should project the anticipated P4P or P4I revenue based on the per-diem payment ranges and incorporate these amounts into FY2025 revenue forecasts. NOTE: This policy applies only to Maryland Medicaid-enrolled nursing facilities with 45+ beds that are not continuing care retirement communities.