Case Mix Reimbursement System Elements. Classification System Case Mix Weights Reimbursement Methodology. Classification System. RUG-III Version 5.1234 Group Model RUGs model currently has the highest predictor of nursing resource requirements Utilizes the Minimum Data Set (MDS) 2.0
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Case Mix WeightsExample Case Mix Index Calculation Determine average adjusted salary minutes for nursing facility population and case mix weights
(See cross walk from existing cost report to the new case mix cost center categories)
Step 1: calculate neutralized direct care plus care related cost for each facility
Step 2: Determine resident day weighted median neutralized direct care plus care related cost
Step 3: Multiply resident day weighted median by 110%
The initial age for each facility shall be determined as of July 1, 2002, for the annual rate year July 1, 2002 – June 30, 2003 using each facility’s year of construction. This age will be reduced for renovations and/or additions of beds that have occurred since the facility was built. If a facility added beds, these new beds will be averaged in with the original beds and a weighted average age for all beds will be used as the initial age.
If a facility performed a major renovation project between the time the facility was built and the time when the initial age is determined, the cost of the renovation project will be used to determine the equivalent number of new beds that project represents. The equivalent number of new beds would then be used to determine the weighted average age of all beds for this facility. The equivalent number of new beds from a renovation project will be determined by dividing the cost of the renovation project by the accumulated depreciation per bed immediately before the renovation project was completed. Facility ages will be rounded to the nearest whole number.
The fair rental value of each facility will be adjusted (increased) to reflect the cost of major renovation / replacement projects completed by each facility during a 24-month period ending prior to a July 1 rate year. The renovation / replacement adjustment would be made at the start of the first rate year following completion of the renovation / replacement project.
The cost of renovation / replacement projects must be documented within each facility’s depreciation schedule, must be reported to the Medicaid program prior to the July 1st rate year when they would first be eligible for incorporation into the FRV rate setting process, and must exceed $500.00 per licensed bed in order to be considered a major renovation /replacement.
Pass through rate is the sum of the facility’s per diem property tax and property insurance cost from the base year period trended forward plus the provider fee determined by the DHH.
When establishing the medians/prices for the administrative and operating and direct care and care related cost centers, cost will be adjusted from the midpoint of each provider’s base year cost report to the midpoint of each state fiscal year using the Nursing Home without Capital Market Basket Index published by DRI, or a comparable index if this index ceases to be published. In non-rebasing years, the medians/prices and property taxes and property insurance cost from the most recent rebasing period will be indexed forward to the midpoint of the current rate year using this indexing methodology.
Cost Report Requirements
Specific Cost Detail
Ancillary/therapy charge schedule
This schedule is used to collect charges for ancillary/therapy services provided to Medicaid and other non-Medicare residents.
Ancillary/therapy charge schedule for specialized services
This schedule is used to separate charges for ancillary/therapy services provided to Medicaid residents only into the following Medicaid resident categories:
Specialized services cost and statistics schedule
Schedule is used to separate the nursing facility’s cost associated with SN/ID, SN/TDC and NRTP from the nursing facility’s standard Medicaid costs
Reconciliation of Medicare allowable cost and Medicaid allowable cost
Schedule is used to report allowable cost claimed on the HCFA 2540 that may be determined as unallowable per Medicaid program reimbursement criteria