What Virginia’s NF VBP is
The General Assembly told the Department of Medical Assistance Services to set up a nursing facility value-based purchasing program in 2021. The 2026 Appropriation Act, Item 291.LLL.2, keeps it running: DMAS must pay out all of the money appropriated for it, by the methodology it publishes each year.
SFY 2027 is the program's fifth year. The pool is $185 million, paid for performance from October 2025 through September 2026. Buildings in Medicaid managed care take part, plus a few outside it. From SFY 2027, Special Focus Facilities and SFF candidates are left out.
The four measures and the cut points
DMAS reads each measure from CMS's public files, not from your own records. Each one is scored on its own, into one of four tiers. The cut points come from the 25th, 50th and 75th percentiles of earlier results, and DMAS published them in October 2025, the first month of the year they score.
| Measure | Weight | Best | Better | Fair |
|---|---|---|---|---|
| Long-stay falls with major injury | 30% | 0–2.03% | 2.04–3.29% | 3.30–4.65% |
| Long-stay pressure ulcers | 30% | 0–3.44% | 3.45–5.22% | 5.23–7.63% |
| Total nurse staffing turnover | 20% | 0–40.30% | 40.31–48.60% | 48.61–58.80% |
| Total nursing hours per resident day, case-mix adjusted | 20% | 3.84 and up | 3.44–3.83 | 3.08–3.43 |
Worse than Fair earns nothing on that measure. The two clinical measures come from the CMS MDS quality measure file on Care Compare. The pressure ulcer measure counts Stage 2 to 4 and unstageable ulcers and is risk-adjusted; falls with major injury isn't. Turnover and nursing hours come from the PBJ staffing data in CMS's Provider Information file. The Fair floor on hours is 3.08, Virginia's minimum staffing standard.
The set changed this year. DMAS retired UTIs and days without eight hours of RN care, paused the hospitalization and ED visit measures, and added turnover and falls with major injury.
What each tier pays
Each measure has a per diem. Best earns all of it, Better 75% and Fair 50%. Your award is that figure times your Medicaid days for the year. These are DMAS's projections from September 2026:
| Per Medicaid day | Best | Better | Fair |
|---|---|---|---|
| Pressure ulcers | $12.50 | $9.38 | $6.26 |
| Falls with major injury | $11.88 | $8.91 | $5.94 |
| Nursing hours | $11.60 | $8.70 | $5.80 |
| Turnover | $8.55 | $6.41 | $4.27 |
DMAS can raise the final per diems if too much is left unearned, or cut them so a measure doesn't go over its share of the pool. Parts of the method still need CMS approval and may change to get it. Moving from Better to Best on pressure ulcers is worth $3.12 a Medicaid day, about $78,000 for a building with 25,000 Medicaid days.
Holding your tier now matters
Federal rules only let the program pay buildings that hold or improve, and DMAS has applied that since SFY 2026. A building that drops one tier from last year gets less than that tier normally pays: Best to Better pays 50%, Better to Fair pays 25%. Drop two tiers and the measure pays nothing. A building whose score held but whose tier slipped because the cut points moved still gets the full rate for its tier.
The improvement pool
Everything not earned goes into a separate improvement pool for each measure. A building that took part last year and improves a measure by 5% or more shares it, by Medicaid days, on top of its tier payment. On falls and pressure ulcers that applies at any tier, Best included.
When your work shows up
SFY 2027 pays for care from October 1, 2025 to September 30, 2026. It comes as two lump sums. Falls and pressure ulcers pay in April or May 2027, from CMS data available in January. Turnover and nursing hours pay in June or July 2027, from April's data. Care from October 2025 is paid about a year and a half later.
Managed care plans pay the buildings in managed care; DMAS pays the rest. Medicaid days come from managed care encounters, with the fourth quarter estimated from the first three. DMAS's decisions are final and can't be appealed, and once a year's data has been used to pay, it is also the baseline for next year's improvement.
See your building’s falls and pressure ulcer rates against Virginia’s cut points.
What moves the clinical measures
- Code J1900C exactly. A skin tear, laceration, bruise or sprain is J1900B, even with an ER visit. One wrong J1900C stays in the measure for about a year.
- Correct it when the injury level changes. If follow-up imaging shows a different level of injury than the one submitted, the RAI Manual requires a modification. That works in both directions.
- Close ulcers before the ARD. An ulcer that healed during the 7-day look-back isn't coded. A healing ulcer keeps its highest stage until it closes.
- Code the risk items. Pressure ulcers are risk-adjusted. A real diabetes or low BMI missing from the MDS lowers the rate CMS expects for you.
What SuperQM covers
SuperQM computes falls with major injury and pressure ulcers per resident, live, for the quarter you're in, from your EHR. It shows each rate against Virginia's cut points, names the residents in the numerator, says when each one clears, and sends the fix to the right person. Those two measures are 60% of the pool, $111 million in SFY 2027.
The other 40% is staffing. For turnover and nursing hours, SuperQM shows the scorecard CMS publishes from PBJ, about two quarters behind. It doesn't forecast them live. See how SuperQM works.
