Nursing homes that provide a minimum of 3.08 hours of daily care per resident will qualify for higher reimbursements from Medicaid, according to a bill that is gaining traction in the Virginia legislature.
Medicaid pays for 60% of Virginia nursing home residents, although Virginia is one of 15 states that do not set minimum staffing standards for nursing homes. Yet that may soon be changing.
The bill, sponsored by Bobby Orrock, R-Spotsylvania, finally overcame opposition from nursing homes after about two decades of efforts to pass minimum staffing standards in the state, as the proposal would tie staffing levels to a value-based framework. The minimum staffing standards can only be enforced as long as payment incentives to nursing homes through the new value-based purchasing initiative also remain in place, officials at the Virginia Health Care Association told the Richmond Times-Dispatch. The lobby group caters to more than 350 nursing homes members across the state.
Virginia joins Illinois in pushing forward legislation that links reimbursements to patient outcomes. Last February, state legislators in Illinois proposed a law that would tie Medicaid reimbursement rates to “demonstrated and sustained nursing home outcomes.”
These initiatives mirror the Biden’s administration’s sweeping nursing home reforms. The federal value-based purchasing program was initially designed to improve patient outcomes by awarding financial incentives or penalties based on a 30-day hospital readmission rate to set a performance and improvement baseline for skilled nursing facilities (SNFs) to meet in order to avoid a penalty.
A previous study published in the Journal of the American Medical Association (JAMA) criticized the Centers for Medicare & Medicaid Services (CMS) program for not offering nursing care facilities a viable path to avoid penalties using readmission rate data. “More SNFs are penalized than given a bonus by design,” JAMA researchers wrote. The journal cited a small number of poor-performing SNFs, a mere 0.7%, were able to improve enough to avoid a financial penalty under the program.
Under the 2023 final payment rule, CMS expanded the federal VBP program to include total nursing hours per resident day as a measure to be considered starting in the 2026 fiscal year, among other new measures.
Those SNFs in Virginia that don’t meet the staffing standard have to make changes and face sanctions that increase in severity if they fail to hit the staffing standard in the following years.
More than 20% of Virginia nursing homes did not meet staffing levels expected by CMS, according to the General Assembly’s Joint Commission on Health Care. The gap is especially large for certified nursing aides, who provide most of the direct care of residents, with almost 60% of homes not meeting expected staffing levels for the aides.
Some Virginia legislators who remain on the fence over approving Orrock’s bill are okay with the 3.08 standard, but are opposed to the bill giving nursing homes as much as five years to meet the standard. Virginia’s proposed staffing minimum standard is similar to Maryland’s but less than Washington D.C.’s 4.16 hours. It is higher than the standards set in other states like North Carolina, Tennessee, Kentucky and West Virginia.
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