This plan amendment updates the cost report total Case Mix Index (CMI), provides for replacement facilities to be designated as new or existing consistent with the criteria used for other new or existing nursing facilities, updates the value-based purchasing (VBP) quality measures and the corresponding per diem adjustments, clarifies the base rate for new facilities having their initial prospective rate set, and provides for the multiple component incentive to be recalculated with the semi-annual and annual rate updates.