Nursing facilities are an essential part of most Medicaid managed long-term services and supports (MLTSS) programs. Improving the quality of care provided by nursing facilities is a goal for states, managed care organizations, nursing facility providers, and facility residents and their families.

This brief, developed with support from the Robert Wood Johnson Foundation, examines four key considerations for states developing nursing facility quality improvement initiatives: (1) using existing data sources when possible to reduce provider burden; (2) enlisting the help of internal or external quality measurement experts; (3) seeking stakeholder engagement and support; and (4) understanding how the initiative may influence beneficiary protections and access to care.

The brief — based on information from several states including Florida, New Jersey, Tennessee, and Texas — can inform state Medicaid agencies interested in developing nursing facility quality improvement efforts within their MLTSS programs.