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HB 3360

Modifies provisions relating to MO HealthNet payments for nursing home services

2026 Regular Session Introduced by Nick Kimble

Missouri's bill would implement a patient-driven, model-based payment system for nursing homes, tying payments for select services to patients' clinical characteristics and adding

Referred: Emerging Issues(H)
#healthcare #medicaid/mohealthnet #nurses #nursinghomesandlong-termcarefacilities
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Bill Summary · HB 3360

Overview

House Bill 3360 (2026) from Missouri proposes to reform MO HealthNet payments for nursing home services by pursuing a patient-driven payment model and updating per diem add-ons. The bill would repeal and replace a current section (208.159) to authorize the Department of Social Services to tailor nursing home payments more closely to individual patient characteristics and to adjust quality-related and workforce-related incentives. It also directs the department to seek federal approval (a waiver or state plan amendment) to implement these changes.

Main purpose and intent

  • Modernize MO HealthNet nursing home payments to be more patient-centered.
  • Link payment calculations to patients’ clinical characteristics rather than solely to volume of services provided.
  • Improve care quality through targeted per diem add-ons and workforce incentives.
  • Remove an existing mental illness diagnosis add-on that provided per diem adjustments based on the percentage of residents with schizophrenia or bipolar disorder.

Key provisions and changes

  1. Authority and framework for payment administration

    • The Department of Social Services would administer MO HealthNet nursing home payments (and related vendor payments for aged services), under rules defined in Chapter 536.
    • The department would define “reasonable costs, manner, extent, quality, charges and fees or payments” for nursing home services.

  2. Patient-driven payment model (PDPM-like approach)

    • The state would apply for a federal waiver or state plan amendment to establish a patient-driven payment model for nursing home services.
    • Payments for certain services would be calculated based on patients’ clinical characteristics rather than the volume of services provided. Specifically, the bill lists:
      • Physical therapy
      • Occupational therapy
      • Speech-language pathology services
      • Nontherapy ancillary services

  3. Per diem add-ons to enhance quality and workforce

    • The model would include per diem add-ons intended to improve quality of care, including:
      • Incentive payments tied to facility performance on specified quality measures.
      • Payments aimed at supporting tenure, promotion, and training of certified nursing assistants (CNAs), with facilities expected to use these funds to increase CNA compensation.

  4. Elimination of existing mental illness add-on

    • The bill would eliminate the mental illness diagnosis add-on that previously provided a per diem adjustment if at least 40% of a facility’s Medicaid participants had schizophrenia or bipolar disorder.

Who would be affected

  • Nursing home facilities participating in MO HealthNet, particularly those serving Medicaid-enrolled residents.
  • Residents receiving MO HealthNet-funded nursing home care, whose payments and potential service mix could shift under a patient-driven model.
  • Certified nursing assistants and related staff, who may benefit from higher compensation through CNA-focused add-ons if facilities enact the intended funding uses.
  • Missouri Department of Social Services and MO HealthNet program administration, which would pursue a federal waiver or state plan amendment and implement new rules.

Procedural and timeline aspects

  • The bill would repeal 208.159 and enact a new section with similar numbering but updated provisions.
  • The department is directed to apply to the Centers for Medicare and Medicaid Services (CMS) for a waiver or state plan amendment to implement the new model.
  • Current actions indicate introduction in February 2026, with committee referrals and subsequent readings in the Missouri House (Emerging Issues H) and potential development pending CMS approval.

Notes

  • The bill emphasizes a shift to clinical-characteristics-based payments for select services and adds quality and workforce-focused incentives.
  • It simultaneously removes a prior add-on tied to mental illness prevalence in facilities.

Compiled from official sources — confirm details with the bill’s official record.

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