I am submitting this comment as the founder of the Connie Taliaferro Initiative for Long-Term Care Reform and as the daughter and advocate of a former Virginia nursing-facility resident.

I support DMAS restricting Nursing Facility Value-Based Payment funding to facilities that demonstrate sufficiently high-quality care. Enhanced payments intended to reward quality should not be paid to facilities with substantiated major quality or safety violations. However, the final methodology should establish clear, objective, and publicly available standards for suspension, forfeiture, reinstatement, and accountability.

When a facility is undergoing a complaint investigation involving major quality or safety concerns, DMAS should suspend its enhanced VBP payment until the investigation is completed. Suspension would protect public funds without treating an unsubstantiated allegation as a final finding.

If the investigation does not substantiate the allegations, DMAS may release the suspended payment. If major quality or safety violations are substantiated, the facility should forfeit its enhanced VBP funding for that program year. Forfeited funds should be redistributed to facilities that meet the program’s quality standards rather than later being returned automatically to the noncompliant facility.

A facility found ineligible should not regain eligibility merely by submitting a plan of correction. Reinstatement in a future program year should require OLC verification that the violations were corrected and that compliance has been sustained. Immediate-jeopardy findings, repeated serious violations, and patterns of substantiated complaints should result in heightened review before eligibility is restored.

DMAS should clearly define “sufficiently high quality,” “major quality or safety issues,” the length of any ineligibility period, and the evidence required for reinstatement. Facility-level decisions—including the amount suspended or forfeited, the reason for the decision, and the facility’s corrective status—should be publicly available.

DMAS should also require every participating facility to demonstrate how its VBP funds were used to improve care for Medicaid residents. Each facility should submit an annual public report identifying:

• The amount of VBP funding received;

• How the funding was spent;

• The resident-care, staffing, or quality problem addressed;

• The measurable improvement produced; and

• Whether the improvement was sustained.

General operating expenses or corporate profit should not automatically qualify as quality improvement. DMAS should audit selected reports, recover funds that were improperly used or reported, and consider a facility’s use of prior awards when determining future eligibility.

Value-Based Payment funding should do more than reward favorable statistics. It should produce identifiable and measurable improvements in residents’ staffing, safety, health, dignity, and daily care. Public reporting would allow residents, families, advocates, and taxpayers to determine whether these enhanced Medicaid payments are accomplishing that purpose.

I respectfully request that DMAS incorporate these accountability, transparency, suspension, forfeiture, redistribution, and reporting requirements into the amended State Plan and annually published VBP methodology.

Michelle Taliaferro
Founder
Connie Taliaferro Initiative for Long-Term Care Reform
connietaliaferroinitiative@outlook.com