The House Appropriations Committee and the Senate Finance and Appropriations Committee have released their respective budget proposals. Today the House and Senate will take the procedural steps to pass their own budget and reject that of the other chamber. Conferees will then be appointed to negotiate the differences between the bills.

Both budgets include funding for the Medicaid forecasts, which includes the regulation-driven inflationary adjustment for Medicaid nursing center services. The actual inflation factor will be calculated closer to the start of the state fiscal year, which begins on July 1.

The House and the Senate have proposed different approaches for additional Medicaid funding. The House budget includes $50 million per year in funding for the Medicaid Nursing Facility Value-Based Payment (VBP) Program. This amount would be in addition to the $93 million funding for the VPB, which has already been allocated in the 2022 SFY budget.

The Senate budget includes language directing nearly $39 million in the second year of the biennium “to ensure certified nursing facilities are reimbursed for meeting a minimum staffing standard for total nurse staffing and registered nurse staffing hours. The total nurse staffing standard shall equal the quarterly Case-Mix Total Nurse Staffing Hours per Resident per Day, and the registered nurse staffing standard shall equal the quarterly Case-Mix RN Staffing Hours per Resident per Day, as published by the Centers for Medicare and Medicaid Services. The staffing standard shall be effective July 1, 2023. The minimum staffing requirement shall complement the nursing home value based purchasing program.” VHCA-VCAL has met with Sen. George Barker, who is the Senate’s chief budget negotiator on health care issues, to discuss the purpose of this language and VHCA-VCAL’s preference for additional funding for the VBP Program.

We continue to emphasize the need to address the underfunding of the Medicaid program and the dramatic staffing losses long term care facilities have experienced since the start of the pandemic. Neither budget included language related to VHCA-VCAL’s broader budget asks related to Medicaid reforms like covering an increased cost for a larger percentage of the Medicaid days, updating occupancy assumptions, reimbursement for the need for some private beds, and facility infrastructure investment opportunities.

Assisted Living Budget Issues

Of note for assisted living providers, the Senate included funding related to the involuntary discharge bill, SB 40. (The House version of the bill (HB 690) was reported out of Health, Welfare and Institutions (HWI) but was tabled in House Appropriations.) The House budget does not contain funding for this purpose. Funding is needed for DSS appeals staff necessitated by the bill. On February 24, the HWI Committee voted to report or refer SB 40 to the House Appropriations Committee. SB 40 has a smaller fiscal impact than HB 690 had.

Neither the House nor the Senate took action to enhance the Auxiliary Grant rate.

Other Budget Items

Other budget provisions of interest to members include:

• Modification of the VBP non-metric based payment to a rate add-on effective July 1 in both the House and Senate budgets. VHCA-VCAL requested this amendment.
• $64K per year for long term care-specific nurse scholarships (32 scholarships valued at $2K each) in both the House and Senate budgets.
• Development of a Nursing Home Quality Improvement Program based on the Joint Commission on Health Care recommendation in both the House and Senate budgets.
• Enhanced funding for The Virginia Home in both the House and Senate budgets.
• Medicaid coverage for customized wheelchairs for NF resident in both the House and Senate budgets.
• ARPA funding for local-government affiliated NFs in both the House and Senate budgets.
• The Senate proposal includes language to defer rebasing for specialized care facilities for one additional year. We will be pursuing support for this measure among House conferees as this deferral is necessary for these providers.

It’s important to remember that the committee budgets are one step in the state budget process. The House and Senate will reject the other’s budget and appoint conferees to work out the differences in the coming weeks. We will continue to emphasize how important a robust Medicaid reimbursement system is to providing high quality care to residents.