Nursing Facility (NF) Value Based Payment Updates from DHHS Forum

• By: Angela Westhoff
• On: 11/06/2025 11:08:38
• In: Legislative/Government Affairs

On October 15^th, DHHS held a forum to provide updates on Nursing Facility Rate Reform, specifically on Value Based Payment (VBP) updates. The slides are available on line here. A recording of the presentation can also be found here. As a reminder, Year 1 (2025) is “pay to participate” model with the vast majority of facilities earning their VBP payment.

Years 2 and 3 are “pay for performance”- 2026 is pay for minimum achievement and 2027 will be pay for performance. The three quality measures are percent staff turnover, antipsychotics, and CoreQ satisfaction surveys. In years 1, 2, and 3 there is a quality bonus pool funded with $8.1 million per year from the Nursing Facility Transition Fund. The Department is calculating the Quality Bonus pool payments for year 1 for those facilities who qualify for a payment. Payments will be proportionate to facilities' Medicaid bed days and are expected to be dispersed before 12/31/25.

For CY 2026, there will be a 1% withhold. Facilities will need to meet a ‘minimum threshold' to earn credit for quality measures on their scorecards (minimum is 20th percentile nationally). The withhold is paid back if each quarter the NF meets a minimum threshold on 2 out of 3 measures (staffing turnover, antipsychotics, and CoreQ). Any funds not earned go back into the quality bonus pool for “high achievers” which the threshold is the higher of the national or state 50th percentile on the quality measures. In CY 2027, the withhold will be 1 or 2% depending upon MaineCare/Maine Veterans Home 70% Program occupancy levels, and facilities will need to meet minimum quality on all measures as outlined in DHHS' slides.

Additional rule making will be coming related to VBP. MHCA will keep members informed regarding rulemaking and public comment periods.

Staff contact: awesthoff@mehca.org