Twenty states and the District of Columbia (DC) use value-based payment (VBP) as part of their nursing facility Medicaid payment system. Most state nursing facility VBP programs include mandatory participation on the part of providers; only California, Colorado, Texas, and DC have voluntary programs. Kansas and Minnesota have both voluntary and mandatory programs. Only the voluntary VBP programs in Kansas and Minnesota have been formally evaluated. Lack of program evaluations hinder states’ ability to learn from programs already implemented in other states. Stakeholders noted that VBP programs are more successful if they include risk-adjusted, clinically meaningful measures. Clinical measures are most often used in state VBP programs, followed by staffing measures, and resident and family satisfaction measures. Nursing facilities may need technical assistance to participate in VBP programs and achieve meaningful changes in quality or costs.
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