The Centers for Medicare and Medicaid Services (CMS) transitioned from the Resource Utilization Groups, Version IV (RUG-IV) case mix model to the Patient Driven Payment Model (PDPM) case mix model. In 2024, the State of Vermont, Department of Vermont Health Access (State) also adopted the PDPM case mix model to incorporate into the nursing home rate setting process. In recognition of this transition, State intends to retain a qualified vendor (Bidder) with fiscal and clinical expertise to assist in maintaining a Medicaid nursing facility reimbursement methodology that meets the unique needs to the state’s residents and providers. Bidder will provide expertise, advice, and methodology development for maintaining and evolving Vermont Medicaid’s PDPM and nursing home rate setting generally. Qualified Bidders will have expertise in the following areas: • Nursing Facility Medicaid rate development; • Fiscal analysis and modeling; • Federal and state regulatory analyses; • Minimum Data Set (MDS) programming and clinical expertise; and • Proven performance in the field of nursing facility rate setting.
