MedicaidReimbursementHigh impact
Nursing Facility Quality Assessment Methodology Change
Maryland Medicaid·MD · Geriatrics, Palliative Care·Nursing Home
Effective date
Jul 1, 2025
We identified it
Sep 5, 2026
Summary
Maryland Medicaid is transitioning nursing facility quality assessment (QA) rates from a non-uniform structure to a uniform percentage model effective July 1, 2025, to comply with new federal Medicaid waiver requirements. For FY 2026, QA rates are adjusted by 0.8%, changing the standard rate from $32.92 to $32.94 per diem, while the rate for the five highest-volume Medicaid facilities decreases from $3.04 to $2.70. Facilities must reconcile Q1-Q3 FY 2026 payments using revised rates, with reconciliation occurring in the Q4 Cognito form due August 29, 2026.
Action Required
By August 29, 2026: Billing team must review the reconciliation sections in the FY 2026 Q4 Cognito form to calculate and apply the revised QA rates retroactively for Q1-Q3 FY 2026. For facilities with the five highest Medicaid days, apply a -$0.34 per diem adjustment; for all other facilities, apply a +$0.02 per diem adjustment. Verify that MMIS has been updated with the new nursing facility rates ($32.94 standard rate and $2.70 for high-volume facilities) to ensure future claims process correctly. If a credit balance results from reconciliation, confirm it is applied toward FY 2027 Q1 payments. Monitor the date announced by Maryland Department of Health for gross adjustment payment processing related to QA Add-On changes. Any outstanding claims after gross adjustments should be resubmitted using standard billing protocol. Contact Jarrod Terry at jarrod.terry@maryland.gov with reconciliation questions.