Ms. Meredith Lee

Policy, Regulations & Manuals Supervisor

Division of Policy & Research

Virginia Department of Medical Assistance Services

600 East Broad Street, Suite 1300
Richmond, 23219

RE:      Intent to Amend State Plan | Nursing Facility Value-Based Payment Updates: Methods & Standards for Establishing Payment Rates for Long-Term Care

Dear Ms. Lee:

Virginians Advocating for Seniors (VAFS), which represents more than half of the Commonwealth’s nursing facility beds, applauds Virginia’s commitment to its Value Based Purchasing Program (VBPP). Robust incentives that focus on the avoidance of negative care events provide the crucial resources necessary to significantly improve outcomes and quality of life for our residents.

On July 31, 2026, the Department of Medical Assistance Services and the Board of Medical Assistance Servies (collectively DMAS) published its Notice of Intent to Amend the Virginia State Plan for Medical Assistance, seeking to exclude from VBPP “facilities under complaint survey due to major quality or safety issues” as well as Special Focus Facilities (SFF).

Federal law requires Virginia to conduct surveys on nursing facilities at least every 15 months. If a facility has received the SFF designation, Virginia must then conduct surveys at least once every six months (no less than twice annually). See §§1919(f)(10) & (g) of the Social Security Act [42 U.S.C. § 1396r].

The Virginia Department of Health (VDH), however, has not conducted timely inspections in over 58% of the Commonwealth’s facilities and does not expect to fix this problem until the end of 2027. In fact, federal data shows that the national average for overdue nursing home inspections is 13%, placing Virginia second to bottom in the national rankings for timely inspections. See A Closer Look at Deficiencies in Nursing Homes, Chidambaram, Burns & Rudowitz, KFF, July 16, 2026 (https://www.kff.org/medicaid/a-closer-look-at-deficiencies-in-nursing-homes/); Nursing Home Inspect, Talbot, Groeger & Ornstein, ProPublica, July 2026 (https://projects.propublica.org/nursing-homes/).

Because of Virginia’s significant lag in inspections, facilities under a complaint survey or in the SFF program do not have an opportunity to demonstrate improvements in quality or seek timely removal of these negative designations. Nevertheless, DMAS seeks to exclude these facilities from receiving the funds necessary to continue their quality improvements, thereby creating a death spiral for these facilities.

Accordingly, VAFS recommends that DMAS amend the State Plan so that “facilities under complaint survey due to major quality or safety issues”  or in the SFF program can participate in VBPP if the Office of Licensure and Certification at VDH fails to conduct timely surveys in accordance with §§1919(f)(10) & (g) of the Social Security Act [42 U.S.C. § 1396r].

Predicating participation in VBPP on VDH’s inspections that fail to comply with federal law unfairly penalizes these facilities and undermines the integrity of the overall program. Accordingly, we look forward to working with you and DMAS to resolve these issues.