Abstract
The link between payment and quality for nursing care provided in long-term care facilities is an emerging trend for many state Medicaid agencies. This article describes a demonstration project that allows nursing facilities more flexibility in how they can spend funds received from the state for Medicaid residents, but also requires accountability for quality of care outcomes. Nursing facilities are encouraged to move from a quality assurance model to a quality improvement model by developing quality of care and quality of life improvement plans. The processes used by facilities to develop these plans and the follow up on the progress and results of the plan are described.