Your facility will have an opportunity to earn up to a 6% increase to your Base Rate (SNF Per Diem and Vent Per Diem Base Rates, as applicable) if you meet all the criteria included in the measures.
2025 SNF Incentive Program
- HMO Blue
- PPO
- Medicare Advantage
(if you are contracted for this product)
This year, the performance period will be November 1, 2024 through
May 31, 2025. To participate in the 2025 SNF Incentive Program you must:
- Be contracted with Blue Cross Blue Shield of Massachusetts as of November 1, 2024.
- Meet our contract conditions of participation.
- Facilities must be open and accept patients for the entire measurement period. They must also remain in good standing with the Massachusetts Department of Public Health, including, but not limited to:
- No Jeopardy and/or Substandard Quality of Care findings.
- No admission freezes.
- No denials of payment.
We will pay for any incentives you earn during the performance period of November 1, 2024 through May 31, 2025 via an increase to your inpatient per diem rates in the 2026 calendar year. The incentive must be re-earned for each performance period. We will not carry these rates forward into subsequent years.
| Measure |
Measure description |
|---|---|
|
Eligibility measures: You must pass these measures before we will evaluate your facility for any of the incentive-earning measures. |
|
|
Provider Central registration |
The person responsible for reporting the data must register for Provider Central, bluecrossma.com/provider, by May 1, 2025. We communicate program updates and reminders online, so it’s important to register. If the person reporting your data doesn’t have access to Provider Central when it’s time to report your performance, we cannot accept your submission. |
|
Ambulance use |
We will audit data from claims submitted with dates of service from November 1, 2024 through May 31, 2025. You must use a participating ground ambulance for 90% of your non-emergent transfers. |
|
Measure |
Measure description |
|
|---|---|---|
|
Incentive measures: You are only eligible to receive payments if you pass the eligibility criteria and submit information for the Transitions of care measure. |
||
|
Incentive measure |
Measure description |
Potential incentive |
|
Quality measures (using CMS Nursing Home Compare1) |
Percentage of short-stay residents who newly received an antipsychotic medication |
Total of 4.0% |
|
Percentage of short-stay residents who had an outpatient emergency department visit |
||
|
Percentage of short-stay residents who were re-hospitalized after a nursing home admission |
||
|
Rate of successful return to home and community from a skilled nursing facility |
||
|
Percentage of short-stay residents whose medications were reviewed and who received follow-up care when medication issues were identified |
||
|
Percentage of residents who are at or above an expected ability to move around at discharge |
||
|
Percentage of infections patients got during their SNF stay that resulted in hospitalization |
||
|
CMS 5-Star rating program results as of July 31, 2025 |
CMS 5-Star results as of July 31, 2025 |
0.5% |
|
Transitions of care |
Learn more: Transitions of care template
 Transitions of care template Note: All responses must include a detailed description of the components to answer the question. If not, you’ll only receive partial credit. |
1.5% |
1You can find measure descriptions on the CMS Nursing Home Compare website.
To be eligible to earn an incentive, you must pass the eligibility criteria (listed above) and submit data for Transitions of care.
Blue Cross Blue Shield of Massachusetts expects discharge planning to begin at admission. As a best practice and to improve health care outcomes, we ask you to:
- Contact the outpatient primary care provider (PCP) for the Blue Cross member and to notify them of the SNF admission.
- Notify the PCP of the discharge home (this includes sending the outpatient PCP a discharge summary that includes medication reconciliation).
CMS quality measures that use publicly reported data
To determine your performance on the total of nine quality and 5-Star measures, we will download data from CMS’ Nursing Home Compare at the end of July 2025. Here’s the methodology we’ll use to determine your quality measure incentive.
Using percentiles as benchmarks
For each quality measure of the Nursing Home Compare data, we identified the Massachusetts 40th and 90th percentiles. Those percentiles will be our benchmarks.
Each benchmark includes a built-in confidence interval. Facilities whose score is below either the 40th or 90th percentile, but still within the confidence interval, are considered to meet the 40th or 90th benchmark. The benchmarks listed below include the confidence interval. We have listed the measures for which a lower percentage means better performance on the measure.
Calculating an incentive based on the benchmarks
Facilities have the potential to earn up to 4.0% for all seven quality measures listed in the table above. If you meet the CMS 5-Star quality measure listed in the table below, it is also worth 0.50%.
This is equivalent to earning Benchmark 3 for all measures.
|
Measure description |
Benchmark 1 |
Benchmark 2 |
Benchmark 3 |
|
|---|---|---|---|---|
|
Percentage of short-stay residents who newly received an antipsychotic medication (the lower the percentage, the better the performance on the measure) |
Greater than 1.51% Earn: 0% |
Between 1.51% and 0.29% Earn: 0.29% |
Equal to 0.28% or lower Earn: 0.57% |
|
|
Percentage of short-stay residents who had an outpatient emergency department visit (the lower the percentage, the better the performance on the measure) |
Greater than 12.11% Earn: 0% |
Between 12.11% and 7.11% Earn: 0.29% |
Equal to 7.10% or lower Earn: 0.57% |
|
|
Percentage of short-stay residents who were |
Greater than 25.88% Earn: 0% |
Between 25.88% and 18.01% Earn: 0.29% |
Equal to 18.00 % or lower Earn: 0.57% |
|
|
Rate of successful return to home and community from a SNF |
Less than 52.69% Earn: 0% |
Between 52.69% and 64.19% Earn: 0.29% |
Equal to 64.20% or higher Earn: 0.57% |
|
|
Percentage of SNF residents whose medications were reviewed and who received follow-up care when medication issues were identified |
Less than 97.1% Earn 0% |
Equal to 97.1% or higher Earn 0.58% |
||
|
Percentage of residents who are at or above an expected ability to move around at discharge |
Less than 37.70% |
Between 37.70% and 59.99% |
Equal to 60.00% or higher |
|
|
Percentage of infections patients got during their SNF stay that resulted in hospitalization (the lower the percentage, the better the performance on the measure) |
Greater than 7.14% Earn 0% |
Between 7.14% and 5.22% |
Equal to 5.21% or lower Earn 0.57% |
|
|
Measure description |
Benchmark 1 |
Benchmark 2 |
Benchmark 3 |
|---|---|---|---|
|
CMS 5-Star Results as of July 31, 2025 |
1-3 Stars |
4 Stars |
5 Stars |
Reporting has closed.
Please do not use non-participating ambulance providers to transport our members when a participating ground ambulance provider is available.
To find a participating ground ambulance provider, use our website’s Find a Doctor feature. Choose the member’s plan and then type Ambulance in the search window. If you need a list of ambulance providers that service your geographic area, please contact your network representative for ambulance providers (see contact information below).
Here’s a partial list of ambulance companies that do not participate in our contracted ground ambulance provider network, and a partial list of private ambulance companies that participate only in our Indemnity product.
| Non-participating providers |
Indemnity only providers (These providers may be used for indemnity members only) |
|---|---|
|
|
- Finding a mental health provider: If you need to refer your patient to an in-network mental health provider, you may use our Find a Doctor & Estimate Costs tool. Or, if you are having difficulty finding one, our Care Management team can help.
- Follow up care: We understand that there may be barriers that members face in following up with the care providers upon discharge. We’d like to remind you that our care managers are always available to support our members. Please contact us if you’d like to refer a patient. Visit our Care Management page to learn more.
For questions about:
- The SNF Incentive Program, please contact Diane Vetrano at Diane.Vetrano@bcbsma.com
or call 1-617-246-4602. - Ambulance providers in our network, please contact Nicole Tully at Nicole.Tully@bcbsma.com
or call 1-617-246-9334. - Provider Central access, please contact the Help Desk at providercentral@bcbsma.com.
As always, thank you for the care you provide to our members.
