Nursing Facility Rate Reform Implementation Key Updates

• By: Angela Westhoff
• On: 12/19/2024 15:52:34
• In: Legislative/Government Affairs

The Maine Health Care Association (MHCA) in partnership with BerryDunn provided a webinar training on the new Nursing Facility rate model and implementation updates on December 19. Tammy Brunetti and Lisa Trundy-Whitten gave an update on the final model that will be implemented as of January 1, 2025 and will be fully adopted in February 2025 when rulemaking is completed. The webinar slides and the recording are available here.

Some Highlights of the NF Model include:

• Costs were updated with 2023 “as-filed” cost report data
• Guardrails updated to allow for a more gradual transition to the new model, including a “hold harmless” provision in year 1, by component.
• Contract staff add-on in Year 1 to temporarily increase assumption to 20% agency labor, to be reduced to 10% in Year 2.
• Occupancy penalty removed from fixed costs.
• Worker's comp has been moved from fixed to routine.
• Value-based payment program pool of $8.1 Million per year in Years 1, 2, and 3 and gradual withhold (no withhold in Year 1). Funds to come from the NF Transition Fund.
• The NF Transition Fund was created (total of $72.8 Million) to enable a more gradual implementation over three year period.

It is important to note that the Department of Health and Human Services (DHHS) has put together a draft Nursing Home Guide for Billing PDPM Nursing Component and an Implementation FAQ document in response to some rate reform implementation questions MHCA submitted. Please note that these are draft documents. DHHS will publish a final copy in the near future and will send out notification via their e-messaging system. MHCA will flag that for members when it becomes available.

In addition, there have been several MDS 3.0 Trainings conducted by the Office of MaineCare Services. All of these handouts and training materials are located here.

As additional details on implementation, billing, and the Value Based Payment (VBP) program become available, we will be certain to share that information with the membership and partners and future education programs are being discussed.

Staff contact: awesthoff@mehca.org