Virginia legislature makes progress on increasing Medicaid nursing home reimbursement rates

Eight policy solutions, aimed at addressing nursing home staff shortages and improving quality of care, received a final assessment from the Virginia Joint Commission on Health Care (JCHC)’s nursing facility workforce work group last week. The workgroup voted on whether or not to recommend each policy to the full JCHC for a formal vote on Dec. 7.

 

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See an overview of the work group’s consensus on each option below: 

Option 1: Direct Virginia Medicaid (DMAS) to develop a plan to increase reimbursement rates for nursing homes, specifically those with more Medicaid residents.

Motion: Recommend to full Commission

Work group members agreed the policy should define the amount of Medicaid residents a nursing facility has to qualify for increased rates, such as 70% or 85% of the total residents.  Others recommended that DMAS’s plan should include a scaled reimbursement system where rates increase as the percentage of Medicaid residents increases.

 

Option 2: Require a baseline number of hours of direct patient care in a day: 3.25 hours per resident, including an RN providing 0.4 hours per resident, OR Option 3: Require nursing homes to provide acuity-based hours of direct patient care.

 Motion: Split recommendation to full Commission

Work group members were split on two recommendations that propose different pathways to increasing quality of care at nursing home facilities. Members who preferred option two argued that an acuity-based model would be difficult to implement across the state, as Medicaid, Medicare, and private facilities would all use different metrics to determine the number of hours they would need.

Supporters of option three argued that an acuity-based model would align better with DMAS’ value-based purchasing program for nursing facilities, which is set to go live in July 2022.

Delegate Patrick Hope (D – Arlington) pointed out that either solution would come with improvements, as the state currently has no policy that places metrics on quality of care.

“I think whatever we decide, we’re talking about injecting a substantial amount of resources into our nursing homes, which is long overdue.” 

 

Option 4: Direct DMAS to develop a nursing home provider assessment, which would generate revenue for the state’s share of covering Medicaid. 

Motion: Do not recommend to full Commission

Work group members supported increased funding for Medicaid, but agreed to seek funding through general funds first, rather than through the assessment.

 

Option 5: Funding for the Long-Term Facility Nursing Scholarship for CNAs, LPNs, and RNs. 

Motion: Recommend to full Commission

The work group recommended this option without discussion.

 

Option 6: Direct DMAS to establish a quality improvement program on building nursing home capacity.

Motion: Recommend to full Commission

The work group recommended this option without discussion.

 

Option 7: Provide DMAS with funds to conduct an evaluation of its Value-based Purchasing Program for nursing home staff.

Motion: Recommend to full Commission, with addition

Delegate Vivian Watts (D – Fairfax) advocated for the inclusion of evaluating the need for de-escalation training for nurses responding to residents experiencing mental health crises. Senator Jen Kiggans (R – Virginia Beach) agreed on the “invaluable” nature of additional training:

“Not only do [the trainings] give a break for the staff and for everyone to regroup … it’s just a great time to come together, to refocus, [and] to educate. If you teach the staff how to handle these dementia patients, they’re going to spend less time, because they know what to do now when they have those challenges.”

 

Option 8: Direct DMAS to enhance reimbursement when caring for residents with behavioral health diagnoses.

Motion: Recommend to full Commission

The work group recommended this option without discussion.

 

New proposed option: The Virginia Community College System (VCCS) requests $119.4 million in general funds over three years to increase its capacity for educating and training nurses.

Motion: Recommend to full Commission

The work group recommended this option without discussion.