Nursing Home Rate Reform Updates

• By: Angela Westhoff
• On: 10/24/2024 11:47:58
• In: Legislative/Government Affairs

On October 23^rd, the Department of Health and Human Services held a public forum to provide updates on the changes to the proposed new Nursing Home rate model. The PowerPoint slides are now posted on the DHHS MaineCare Rate Reform website here. We anticipate a recording of the presentation will also be posted to the MaineCare Rate reform website as well. Be sure to click on “CY 2024 Rate Determinations- in Progress” and search for Section 67 in the list.

The DHHS presentation focused on new changes to the nursing facility rate model since the original version that was shared in March 2024. The model has been updated with 2023 cost report data and includes changes based upon public feedback and meetings with Maine Health Care Association.

The new rate model includes several transitional features that will be included over a three-year period as part of a phase-in to the new rate methodology. These phase-in features include changes to the original proposed guardrails and the implementation of a hold harmless provision for Year 1. In the direct care portion of the rate, contract staff add-on is included for Year 1 with agency staffing assumption being increased from 10 to 20% for the first year of the new model. Year 1 also includes an upside potential of up to 20%. Graduated guardrails will be in place for Years 1-3 of the implementation and then in year 4 there will be none.

Additionally, the occupancy penalty has been removed from Fixed costs permanently. Worker's Comp has been moved from Fixed to Routine component. The Value Based Payment (VBP) program includes a bonus pool of $8.1 Million per year for three years with a gradual withhold after Year 1. There will also be a new two-tiered Bariatric daily add-on, and additional specialty care add-ons are being contemplated. The transition elements of the new model will be funded with the NF Transition Fund that was approved by the Legislature.

A Response to Comments document will be posted on the rate reform website. Written comments on the changes to the model can emailed to ratereform.oms@maine.gov by October 30^th, 2024.

A State Plan Amendment will be submitted to CMS and rules will need to be adopted. DHHS indicates the new model is still anticipated to launch on January 1, 2025. 

Staff contact: awesthoff@mehca.org