The MO HealthNet Division (MHD) is modifying the reimbursement plan for nursing facility and HIV nursing facility services to provide for the transformation of MO HealthNet nursing facility reimbursement rates by establishing a new reimbursement methodology, effective for dates of service beginning July 1, 2022. The primary changes from the current reimbursement include updating the cost base for the rates (i.e., rebasing), applying an acuity adjustment or Case Mix Index (CMI) to patient care costs, and providing quality based incentives or Value Based Purchasing (VBP) add-ons to the rate when the facility meets specified quality measures.
The following documents can be found at the MO HealthNet Alerts and Public Notices webpage:
- Public Notice of Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility
- Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services
An additional resource, The Missouri Medicaid Nursing Facility Reimbursement Methodology Summary for Fiscal Year 2023, created by MO HealthNet, provides a summary of the changes for the reimbursement plan found in the Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services document.