Nursing Facility Bonus Payments

The Health Plan of San Mateo (HPSM) offers bonus payments for quality performance to in-network nursing facilities providing skilled and/or long-term care services to our Medi-Cal and CareAdvantage members. In-network facilities are automatically opted-in to the following upside-only bonuses:

1. Nursing Facility Quality Payment Program (“NF QPP”): The NF QPP offers bonus payments based on performance in quality metrics designed to improve HPSM member bed access, reduce inpatient and emergency department utilization, and improve care transitions.
2. Community Discharge and Retention Incentive for Long-Term Care only: This incentive offers long-term care facilities bonus payments for successfully discharging HPSM members with extended institutional stays to a community setting where they remain for a continuous six months or more.
   

For questions on these bonuses, or how to become a part of the HPSM network, please contact HPSM Provider Services at PSInquiries@hpsm.org.

Resources

Skilled and/or Long-Term Care

The NF QPP Program Guidelines contain comprehensive information on program structure and quality performance metrics.

• 2023 Nursing Facility Quality Payment Program Guidelines - DRAFT

Long-Term Care (For LTC Providers Only)

The incentive overview below provides information on the eligibility requirements for a credited discharge and community retention.

• 2023 LTC Community Discharge & Retention Incentive Overview - DRAFT