What the Missouri VBP is
The Value Based Purchasing (VBP) Incentive is an add-on to the Medicaid per diem that MO HealthNet, Missouri's Medicaid program, pays nursing facilities. It came in with the July 2022 rate rebasing and is written into 13 CSR 70-10.020, the nursing facility reimbursement rule of the Department of Social Services. Every facility with a Missouri prospective rate is scored.
It has two layers. A building earns a fixed amount per Medicaid day for each of seven CMS long-stay measures it keeps at or under a fixed line. Then that total is multiplied by a percentage set by its overall quality score. Every input is a CMS MDS quality measure. There is no staffing or survey part.
The seven lines
Each line is the best-performing band of CMS's Five-Star cut points as they stood in January 2017, rounded to a tenth. The rule adopts that version of the table and none after it, so the lines don't move when CMS updates Five-Star. Today's Five-Star cut points are a different set.
| Long-stay measure | Missouri line |
|---|---|
| Need for help with daily activities increased | 10.0% or less |
| Ability to walk independently worsened | 8.0% or less |
| Pressure ulcers (high-risk residents) | 2.7% or less |
| Antipsychotic medication | 6.8% or less |
| Falls with major injury | 1.3% or less |
| Catheter inserted and left in the bladder | 1.1% or less |
| Urinary tract infection | 1.9% or less |
The lines are tight, and each one is pass or fail. Counted across four quarters, 4 UTIs in 220 residents is 1.8% and earns the full amount. A fifth makes it 2.3%, and that measure earns nothing.
Two of the names are older than the current measures. Missouri's rule still names the high-risk pressure ulcer measure, which CMS replaced in October 2023. And the long-stay antipsychotic measure CMS publishes has blended Medicare claims with the MDS since January 2026.
The second layer: the tier
The per-day total is then multiplied by a VBP percentage. Missouri scores eight long-stay measures, the seven above plus physical restraints, on the same January 2017 table. Each earns 20 to 100 points by band, and the points are added up, out of 800.
| Quality points | VBP percentage |
|---|---|
| 600 and up | 100% |
| 520 to 599 | 75% |
| 440 to 519 | 50% |
| 360 to 439 | 25% |
| Under 360 | Nothing |
The rule's own example: a building that earns $2.00 in lines, at the 75% tier, gets $1.50 a day. The two layers pull on each other. A building can meet every line and still collect half the money if its other bands are low. Restraints earns points but no line of its own.
These are Missouri's points, not today's Five-Star points. On current Five-Star, some measures are worth 150 and the cut points are newer.
What it pays
For dates of service from July 1, 2025, each line met is worth $3.42 per Medicaid day. Missouri has raised it every year since the program began:
| Rates from | Per line | All seven |
|---|---|---|
| July 2022 | $1.00 | $7.00 |
| July 2023 | $1.87 | $13.09 |
| July 2024 | $3.04 | $21.28 |
| July 2025 | $3.42 | $23.94 |
The July 2025 step was adopted in April 2026 and applied back to July 1, 2025. As of the October 1, 2026 Missouri Register, no change for the year starting July 2026 had been filed, so $3.42 stands.
The add-on is part of the building's MO HealthNet per diem rate. At the 100% tier, one line is worth about $86,000 a year for a building with 25,000 Medicaid days. Missouri doesn't publish a statewide total or facility results.
See your building’s long-stay measures against Missouri’s lines.
When your work shows up
Missouri recalculates the add-on twice a year, for the January 1 and July 1 rates. It reads each building's 12-month rolling value from the latest CMS data as of November 15 for January, and as of May 15 for July. CMS refreshes its quality measures usually in January, April, July and October, so July reads the April refresh and January reads October's.
Nothing carries over on its own. A building has to meet each line again every period, and loses the add-on for any line it no longer meets. If CMS has no new data for a building, Missouri carries the prior period forward.
What moves the add-on
- Know which lines are close. On a 1.1% or 1.3% line, one resident decides the measure. Track it by resident, not by quarter.
- UTIs only when they meet the definition. I2300 needs both the evidence-based criteria and a physician diagnosis in the 30-day look-back.
- Code J1900C exactly. Major injury means a fracture, a dislocation, a closed head injury with altered consciousness, or a subdural hematoma.
- Code the catheter exclusions. The catheter line is 1.1%, the tightest of the seven. An active neurogenic bladder or obstructive uropathy, when the physician has documented it, belongs on the MDS and takes the resident out of the measure.
- Watch the tier as well as the lines. A measure in a low band costs tier points even when it has no line, as restraints does.
How SuperQM helps Missouri buildings
Missouri's formula is built entirely from CMS long-stay MDS measures, and SuperQM computes those from your own charting, for the quarter you're in. It shows each measure against Missouri's line, the residents behind it and when each one clears, and sends the fix to the MDS coordinator. The one part it can't see is the Medicare claims side of CMS's antipsychotic measure, so that one shows the MDS side only. See how SuperQM works.
