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

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.