WYOMING DEPARTMENT OF HEALTH
TIME-WEIGHTED CASE MIX
REIMBURSEMENT
5/28/15
RESOURCES
•
Relevant presentation materials including this Power Point and
supporting documents can be downloaded from the following website:
•
http://www.mslc.com/Wyoming/Downloads.aspx
•
Click on “Long Term Care – New Rate System Implementation
Effective July 1, 2015”
•
Click on “2015-05-28 Webinar materials”
CONTACT INFORMATION
Tammy Martin
Tammym@mslc.com
800.336.7721
Jan Courtney
Janc@mslc.com
800.263.5339
REIMBURSEMENT
TAMMY MARTIN
BASIC ELEMENTS
• No changes to annual cost report filing
requirements or audit requirements
• No changes to UPL/tax process
• Cost reports used to determine audited
exempt costs for rates, cost coverage
percents, and UPL calculations
• 2013 cost report used for 7/1/15 rate, etc.
• Annual rate period changing to July 1 through
June 30
RATE CATEGORIES
1. Healthcare a. case mix adjusted for acuity
b. price based
2. Property –
a. price based
b. Based on building age
RATE CATEGORIES
3. Exempt –
a. cost based
b. Audited cost report information
4. Operating –
a. price based
QUARTERLY RATE SETTING
 Quarterly rate adjustments
 Only healthcare component changes for
Medicaid acuity
 Quarterly rates effective:
July 1
October 1
January 1
April 1
BASIC ELEMENTS CONTINUED
• Entire system is driven by legislative
funding
• All prices and rates will be based on
spending the legislative funding
allotment
HEALTH CARE COMPONENT
Price – Based Acuity Adjusted
• Medical records
• Social services
• Nursing wages (RN, LPN, NA, CNAs, and
contracted nursing wages)
• Payroll taxes and benefits associated with
these wages
HEALTH CARE COMPONENT
• Starting fixed base price
• Same starting price to all providers.
• Price adjusted up or down each quarter
based on the provider’s acuity level for
the quarter.
HEALTH CARE – CASE MIX
ADJUSTMENT FORMULA
Fixed healthcare price
x Your facility’s Medicaid acuity score
/ Total statewide Medicaid weighted day average
acuity score
HEALTHCARE CASE MIX ADJUSTMENT
EXAMPLE
Description
Provider A
Provider B
Starting base price
$80.00
$80.00
MCD Acuity for Quarter
.9000
1.100
Statewide Avg Acuity
1.000
1.000
Ratio
.9000
1.100
Case Mix Adjusted Rate
$72.00
$88.00
PROPERTY COMPONENT
Price - Based
• Leasehold amortization
• Rent / lease expense
• Depreciation
• Interest on real estate and property
PROPERTY HIGHLIGHTS
• Fixed price based on the age of each
provider’s building.
• The younger the building age, the
higher the rate
• Buildings > 40 years old paid as if 40
PROPERTY HIGHLIGHTS CONT.
• Building ages determined in 2015 based on
a capital cost survey.
• Historical construction date plus the cost of
all remodels over time = 2015 base building
age.
• Every building ages by 1 year every July 1
PROPERTY RE-AGE ADJUSTMENTS
• Re-age adjustments can happen. If buidling
improvements made we can apply a formula to
determine the age reduction.
• If Re-age = 1 year, adj applied the next July 1.
• If re-age >1, applied the next rate quarter.
• No mid quarter or retrospective re-age
adjustments.
PROPERTY RE-AGE ADJUSTMENTS
• Provider duty to notify Dept when
remodel happens if they want it
looked at for an upcoming rate quarter
or year.
• If MSLC stumbles on one in the audit,
the re-age will be applied moving
forward, but never retrospectively.
EXEMPT COMPONENT
Cost – Based – Pays audited cost of the
following
• Property taxes
• Property insurance
• Utilities
• Nurse aid training - Costs for testing, books,
fees, and classes for completing the Nursing
CNA exam. Wages and benefits of employees
while they are being trained are not considered
an exempt cost
OPERATING COMPONENT
• Price based
• Same rate paid to all providers regardless of
their cost.
OPERATING COMPONENT
• A&G
• Central services
• Plant
• Routine supplies
• Laundry
• Pharmacy consultant
• Housekeeping
• Activities
• Cafeteria
• Payroll tax & bens
• Dietary
• All other costs not
mentioned in HC,
exempt & property
• Nurse admin
BED RANGE ADJUSTMENTS
• Concept
• Smaller providers have the same fixed
overhead to spread over less beds.
• Decrease rates to larger facilities to allocate
to smaller facilities
• Cost coverage – goal is to reallocate funding
to ensure cost coverage %s that are
relatively the same to all bed range groups.
QUESTIONS?
Jan Courtney
Time Weighted Case Mix
System
INTRODUCTION
•
The Wyoming Department of Health has contracted with Myers and
Stauffer LC to develop a case mix reimbursement system for
Wyoming’s Medicaid nursing facilities.
•
Implemented with rates effective July 1, 2015
•
A portion of the rate is adjusted based on the case mix of the
residents in each facility
•
The source of the case mix rate element is the Minimum Data Set
(MDS) which is transmitted electronically to the Quality Improvement
and Evaluation System (QIES) Assessment Submission and
Processing (ASAP) System
SCHEDULE OF CASE MIX
ADJUSTMENTS
Used to Adjust Rates
Effective:
Case Mix Measure Obtained on the
Following Dates Preceding the Rate
Period:
January 1 – March 31
July 1 – September 30
April 1 – June 30
October 1 – December 31
July 1 – September 30
January 1 – March 31
October 1 – December 31
April 1 – June 30
POINT-IN-TIME CMI RESIDENT
ROSTERS
•
Only being used for the 7/1/15 Rates, using 4/1/15 as the Point in
Time or Picture Date
•
A list of residents for each Medicaid certified nursing facility where the
most recently completed/accepted MDS is on or before 4/1/15
•
Residents who discharge on or before 4/1/15 are not displayed unless
they return prior to 4/1/15 and have a valid assessment accepted
•
New admissions will only display if the first assessment is completed
(Z0500B) on or before 4/1/15 and accepted into the QIES ASAP
system
•
A case mix index is assigned to each MDS assessment .
•
From this information, a facility-wide case mix index is calculated.
TIME-WEIGHTED CMI RESIDENT
ROSTERS
•
Effective with 10/1/15 rates using the quarter ending 6/30/15.
•
A list of residents for each Medicaid certified nursing facility
•
Displays each resident who resided in the nursing facility during the
Resident Roster quarter based on MDS assessments and tracking
forms transmitted to the QIES ASAP System and accepted by that
system
•
A case mix index is assigned to the period of the quarter related to
each MDS assessment and tracking form.
•
From this information, a day weighted case mix index is calculated.
TIME-WEIGHTED CMI RESIDENT
ROSTER ELEMENTS
•
RUG-IV 48-Group Classification Model, Version 1.03
•
Case Mix Index (CMI) set is the standard nursing-only CMI set
published by CMS, identified as F01
•
Index Maximization is used to assign each resident to the final RUGIV classification.
•
Days attributable to expired (inactive) assessments or tracking forms
are categorized as BC2
•
There will be a “phase-in” period for 6 months where the default RUG group for inactive
assessments will not be used to calculate a facility’s time-weighted average
•
Effective with the 4/1/16 rate (using MDS data from the quarter ending 12/31/15) all
expired or inactive assessments will be categorized with the default RUG group of BC2
and will be included in the calculation of the facility’s time-weighted average.
• Identification of MDS Records depends on the coding at
A0310
• In many instances, reasons for assessment are combined.
• Identified on Roster Report using the item set code followed
by the submitted values in A0310A,A0310B,A0310C and
A0310F
• For example the record type shown on the Roster Report
as NT/99/99/0/01 indicates the Entry Tracking Form
• NQ/02/99/0/99 indicates an OBRA Quarterly
RUG IV, 48 GROUP VERSION
1.03 CMI SET F01
RUG-IV Classification
CMI
ES3
3
ES2
Extensive Service
2.23
ES1
2.22
RAE
1.65
RAD
1.58
RAC
Rehabilitation
1.36
RAB
1.1
RAA
0.82
HE2
1.88
HE1
1.47
HD2
1.69
HD1
Special Care-High
1.33
HC2
1.57
HC1
1.23
HB2
1.55
HB1
1.22
RUG-IV Classification
CMI
LE2
1.61
LE1
1.26
LD2
1.54
LD1
Special Care-Low
1.21
LC2
1.3
LC1
1.02
LB2
1.21
LB1
0.95
CE2
1.39
CE1
1.25
CD2
1.29
CD1
Clinically Complex
1.15
CC2
1.08
CC1
0.96
CB2
0.95
CB1
0.85
CA2
0.73
CA1
0.65
RUG-IV Classification
CMI
BB2
0.81
BB1
BA2
Behavioral Symptoms &
Cognitive Performance
0.75
0.58
BA1
0.53
PE2
1.25
PE1
1.17
PD2
1.15
PD1
1.06
PC2
Reduced Physical Function
0.91
PC1
0.85
PB2
0.7
PB1
0.65
PA2
0.49
PA1
0.45
BC2
Inactive/Expired
0.45
TIME-WEIGHTED CMI RESIDENT
ROSTER DETAILS
• Distribution Schedule
Resident Roster Report
Schedule
12/31
03/31
06/30
9/30
Preliminary Report Cutoff Date
01/15
04/15
07/15
10/15
Preliminary Report Posting Date
01/25
04/25
07/25
10/25
Final Report Cutoff Date
02/10
05/10
08/10
11/10
Final Report Posting Date
03/01
06/01
09/01
12/01
• Reports will be distributed via the Myers and
Stauffer Secure FTP Site
• Selection of Residents and Records
•
All residents for whom an assessment and/or tracking form have
been completed and accepted into the QIES ASAP system within
the Resident Roster Quarter and by the Report cutoff dates.
•
Residents who discharged on or before quarter begin date and
who do not return during the quarter will not be listed.
•
Assessment and tracking forms for each resident are displayed in
sequential date order.
•
Latest assessment or tracking forms from the prior quarter
•
All assessments and tracking forms for the current Resident Roster Quarter
•
Residents are identified on the Roster Report using the information
coded on the MDS assessment at the record locations described in
the table below.
MDS 3.0 Location
•
Description
A0500A
First name
A0500C
Last name
A0600
Social Security Number
A0800
Gender
A0900
Birth Date
Assigned by QIES ASAP System
Resident ID
Resident ID is assigned by the QIES ASAP system and uniquely
identifies a resident.
Resident Roster
Elements
MDS 3.0 Location
Description
Record Type
Determined from values at A0310 A, B, C, F.
Target Date
Assessment Reference Date (A2300) or Discharge Date (A2000) or
Entry/Reentry Date (A1600).
A record assigned one of the 48 RUG-IV groups.
RUG-IV Classification
Start Date
Case Mix Index
Calculated from:
 a date within the record, or
 a date within the preceding record, or
 start of the quarter.
The location where the Start Date was obtained, if the date was
obtained from the displayed record.
Calculated from:
 a date within the record, or
 a date within the following record, or
 the last date the record is active, or
 the end of the quarter.
Calculated as the number of days between the Start Date and End
Date, if any.
A numerical score assigned to each of the RUG-IV classifications.
Payment Source
Determination of Payment Source; Medicaid, Medicare, and Other.
Start Date Field
End Date
Days
• Resident Roster Summary
• summary of the total number of days at each
RUG-IV classification
• Calculated number of CMI points by payment
source
• Day weighted CMI average for residents by
payment source
CALCULATION OF DAYS
• Transmission of appropriate assessments in
logical sequential order, coded with accurate
dates will result in an accurate count of days
•
General Rules
•
A. Inactivated records (A0050=3) are not considered in the creation of the Resident Roster
•
B. Modified records (A0050 = 2), only the record with the highest Correction Number (X0800)
is considered.
•
C. Calculation of days includes day of admission, day of discharge is not included
•
D. Days are counted from the first day of the quarter until the earliest of:
•
ARD (A2300) of the next assessment
•
End of the quarter
•
Discharge
unless the maximum number of days for the assessment has been reached.
•
E. Days covered by temporary home visits, temporary therapeutic leave and
hospital observational stays less than 24 hours where the hospital does not admit
the resident are included in the count of days since CMS does not require a
discharge assessment to be completed
• Expired Assessment
• Each assessment is considered active for a maximum of 106
days, measured from the ARD (A2300).
• An assessment not followed by any other assessment,
Discharge, or Death in Facility tracking form within 106
days of the preceding record’s ARD is considered an
expired assessment (or inactive).
• During the inactive period following an expired
assessment (starting on day 107) until the start of the
next assessment (A2300) or the end of the quarter, days
are counted at the delinquent RUG-IV classification BC2.
In this example:
•Quarterly assessment was transmitted with the ARD (A2300) 10/14/2014
•The subsequent Quarterly assessment was transmitted with the ARD (A2300)
03/15/2015
End
Date
Days
Case
Mix
Index
01/01/15
01/28/15
28
0.85
Medicaid
BC2
01/29/15
03/14/15
45
0.45
Medicaid
CB1
03/15/15
03/31/15
17
0.85
Medicaid
Total Days
90
Record
Type
Target
Date
RUG
Class
Start
Date
NQ/02/99/99
10/14/14
CB1
NQ/02/99/99
10/14/14
NQ/02/99/99
03/15/15
Start Date
Field
A2300
Payment
Source
•Adding 106 days to the A2300 date of the 10/14/14 Quarterly assessment results in 01/28/15.
•This assessment is consider expired from 1/29/15 (107th day) until the day before the A2300 date of
the 3/15/15 Quarterly assessment. The expired days are given a delinquent RUG-IV classification of
BC2
•The days from the second Quarterly assessment count from the ARD (03/15/2015) until the end of the
quarter.
Late Admission Assessment
•
CMS requirements allow no more than 14 days between the
admission entry date (A1600) and the Admission assessment
reference date (A2300).
• For purposes of Wyoming Medicaid reimbursement, when there
are more than 14 days, the entry date is used to begin counting
days for the Admission assessment up to a total of 14 days.
• Any remaining days beginning on day 15 through the day prior
to the assessment reference date (A2300) will result in the
delinquent RUG-IV classification BC2.
In this example:
• Entry Tracking Form was transmitted with the Entry date (A1600)
12/12/2014
•The Admission assessment was transmitted with the Assessment
reference date (A2300) 01/24/2015
•Entry date (A1600) on Admission assessment 12/12/2014
•A Discharge assessment was transmitted with the Discharge date
(A2000) 03/02/2015
Case
Target
Record
Type
Date
RUG
Class
Start
Date
NT/99/99/01
12/12/14
BC2
01/01/15
NC/01/99/99
01/24/15
CC2
ND/99/99/11
03/02/15
Start
Date
Field
End
Date
Days
Mix
Index
Payment
Source
01/23/15
23
0.45
Medicaid
01/24/15 A2300 03/01/15
37
1.08
Medicaid
03/02/15 A2000 03/02/15
Total
days
60
•Delinquent days begin on the start of the quarter because the entry date of
12/12/2014 is greater than 14 days prior to the ARD of 01/24/2015 of the
Admission assessment.
•Days begin counting on the ARD of 01/24/2015 of the Admission assessment
through the day prior to the discharge date of 03/02/2015.
Discharge Assessments
• When a series of Discharge assessments is
submitted with no assessment in between, the
earliest discharge date in the series stops the
count of days.
In this example:
a Quarterly assessment precedes the start of the quarter followed by a
Discharge assessment (return anticipated) and then followed by a
Discharge assessment (return not anticipated)
•Quarterly assessment ARD (A2300) 12/10/2014
•First Discharge assessment Discharge date (A2000) 01/15/2015
•Second Discharge assessment Discharge date (A2000) 02/01/2015
Case
Target
Record
Type
Date
NQ/02/99/99 12/10/14
ND/99/99/11 01/15/15
ND/99/99/10 02/01/15
RUG
Start
Start
Date
End
Class
Date
Field
Date
PB1
01/01/15
01/14/15
01/15/15 A2000 01/15/15
Mix
Payment
Days
Index
Source
14
0.65
Medicaid
02/01/15 A2000 02/01/15
Total
Days
14
•The first discharge date of 01/15/2015 stops the count of days for the Quarterly
assessment on the day before the discharge date.
.
Entry Tracking Form
•
If an Entry Tracking Form is not preceded by an assessment for a new
stay in the facility and is followed by a Discharge assessment or Death in
Facility Tracking Form, the RUG-IV classification will be assigned as
follows for the days starting from the entry date (A1600) to the day prior to
the discharge date (A2000) up to a maximum of 14 days:
•
LD2 – when discharge status was deceased (A2100 = 08) or
transferred to the hospital (A2100 = 03, 05, or 09)
•
RAB – when discharge status was other than death or transferred to
the hospital (A2100 = 01, 02, 04, 06, 07, or 99)
In this example:
• the Entry Tracking Form was transmitted with the Entry date (A1600)
12/25/2014 and (A1700 = 1, Admission)
•The Discharge assessment was transmitted with the Discharge date (A2000)
01/07/2015 and Discharge status was deceased (A2100 = 08)
Case
Target
Record
RUG
Start
Start
Date
End
Field
Date
01/06/15
Type
Date
Class
Date
NT/99/99/01
12/25/14
LD2
01/01/15
NT/99/99/12
01/07/15
01/07/15
A2000
Mix
Payment
Days
Index
Source
6
1.54
Medicaid
01/07/15
Total
Days
6
•When an Entry Tracking Form is the first and only record for a new resident that
is followed by a Discharge assessment, the RUG-IV classification and
associated CMI are based on the discharge status (A2100); either LD2 or RAB.
•In this case the discharge status is (08) deceased; resulting in a RUG
classification of LD2.
•The Entry Tracking Form must be coded A1700 = 1 (Admission).
.
Entry Tracking Form
•
Entry Tracking Forms are required to be submitted for each entry or
reentry into the nursing facility. The entry date (A1600) indicates the exact
date of entry and is used to begin the counting of days. However, the
Entry Tracking Form is not an assessment and therefore is unable to be
classified.
In this example:
• a Quarterly assessment prior to the start of the quarter was followed by a Discharge assessment (return anticipated).
•Later, an Entry Tracking Form was submitted followed by an Admission/5-day PPS assessment
•Quarterly assessment ARD (A2300) 11/15/2014
•Discharge assessment Discharge date (A2000) 01/06/2015
•Entry Tracking Form Entry Date (A1600) 03/01/2015 and (A1700 = 1, Admission)
•Admission/5-day PPS assessment ARD (A2300) 03/13/2015 and the entry date (A1600) 03/01/2015
Case
Target
Record
Type
NQ/02/99/99
ND/99/99/11
NT/99/99/01
11/15/14
01/06/15
03/01/15
NC/01/01/99
03/13/15
Date
RUG
Class
ES2
ES3
Start
Date
Field
Start
Date
01/01/15
01/06/15
03/01/15
A2000
A1600
End
Date
01/05/15
01/06/15
03/01/15
03/01/15
A1600
03/31/15
Total
Days
Days
5
Mix
Index
2.23
Payment
Source
Medicaid
31
3
Medicare
36
•Days begin counting for the first assessment on the first day of the quarter through the day prior to
the discharge date (A2000) 01/06/2015.
•The Entry Tracking Form is transmitted followed by an Admission/5-day assessment and begins
counting at the entry date, 03/01/2015, through the end of the quarter.
• The Entry Tracking Form must be coded A1700 = 1 (Admission)..
Entry Tracking Form
•
If the Entry Tracking Form is not followed by an assessment, but is
preceded by an assessment that has not expired, the remainder of the
unexpired days from the preceding assessment is used for the count of
days starting at the entry date.
In this example:
• a Quarterly assessment prior to the quarter was following by a Discharge assessment (return
anticipated). Later, an Entry Tracking Form was submitted but was not followed by an assessment.
•Quarterly assessment ARD (A2300) 12/30/2014
•Discharge assessment Discharge date (A2000) 01/06/2015
•Entry Tracking Form Entry Date (A1600) 01/15/2015 and (A1700 = 2, Reentry)
Case
Target
Record
Type
NQ/02/99/99
ND/99/99/11
NT/99/99/01
Date
12/30/14
01/06/15
01/15/15
RUG
Class
ES2
ES2
Start
Date
01/01/15
01/06/15
01/15/15
State
Date
Field
A2000
A1600
End
Date
01/05/15
01/06/15
03/31/15
Total
Days
Days
5
Mix
Index
2.23
Payment
Source
Medicaid
76
2.23
Medicaid
81
•The Entry Tracking Form is transmitted but is not followed by an assessment. Since there is
no new assessment within 14 days from the reentry date, the RUG-IV classification is taken
from the preceding active assessment.
•The Entry Tracking Form must be coded A1700 = 2 (Reentry) and must be within 30 days of
the discharge.
•The preceding discharge must be coded as Discharge Return Anticipated (A0310F = 11)
Missing or Out of Order Assessments
•
When an Admission assessment is preceded by an assessment, the days
counted for the Admission assessment begin from the assessment
reference date (A2300) on the Admission and not the entry date (A1600).
In this example:
• A Quarterly assessment was followed by an Admission assessment
• Quarterly assessment ARD (A2300) 12/15/2014
•
Admission/5-day Medicare assessment ARD (A2300) 02/21/2015 including an entry date
(A1600) 02/10/2015
Record
Type
Target
Date
RUG
Class
Start
Date
NQ/02/99/99
12/15/14
LD1
01/01/15
NC/01/01/99
02/21/15
ES1
02/21/15
Start
Date
Field
A2300
End
Date
02/20/15
Days
51
Case
Mix
Index
1.21
Medicaid
03/31/15
39
2.22
Medicare
Total
Days
Payment
Source
90
•An Admission assessment should only be completed on admission and
should be preceded by an Entry Tracking Record. This is considered “Out
of Sequence”.
DETERMINATION OF PAYMENT SOURCE
The payment source (Medicaid, Medicare or Other) identified on the Resident Roster is
determined from the assessment record as follows:
•
A non-PPS assessment or tracking form where MDS item A0700 Medicaid Number is
submitted with a valid recipient number are counted as Medicaid payment source.
•
A valid Wyoming Medicaid recipient number is a ten (10) digit number, beginning with
a zero (0).
•
Medicaid pending coded with the "+" symbol or other variations of Medicaid pending in
MDS item A0700 Medicaid Number, are counted as Other payment source, unless the
assessment in MDS item A0310B are identified with a PPS reason; then Medicare
payment source is assigned on the detail pages of the Resident Roster.
•
All assessments with a PPS reason for assessment in MDS item A0310B are identified
as Medicare payment source
•
Any assessment not identified as either Medicare or Medicaid are assigned as Other
payment source
REVIEW OF RESIDENT ROSTER
• The Preliminary Resident Roster is provided as a tool for use
by the facility in determining whether any missing or incorrect
records are noted
• Allows a review period for the facility to evaluate records
displayed on the roster
• All corrections to the Preliminary Resident Roster must be
made on or before the cutoff date through the modification,
inactivation and transmission process for MDS assessments
and tracking forms in accordance with the RAI manual (Chapter
5) and CMS correction policy
• No manual alterations of the Resident Roster are considered
The following steps are suggested when reviewing the Preliminary Resident
Roster
•
Determine if all residents in the facility at any time during the quarter are listed
on the Resident Roster.
•
Determine if each resident is identified only once.
•
If the same resident appears as if they were two separate residents, contact the State RAI
Coordinator to merge resident records.
•
Review the listed assessments and tracking forms for each listed resident to
determine if each record is accounted for on the Resident Roster.
•
Review the start date and end date for accuracy.
•
Determine if each Medicaid resident is correctly identified as Medicaid for any
non-PPS assessment days by reviewing MDS item A0700 Medicaid Number.
•
Review any BC2 RUG classifications
•
if appropriate, submit any completed missing assessments or tracking forms or
•
complete any modifications of previously transmitted records, when applicable, to correct
the reason causing the BC2 RUG classification assignment.
•
Keep in mind that assessments may have already been transmitted after the cut-off date of
the Preliminary Resident Roster and will automatically be listed on the Final Resident
Roster.
•
Review the RUG-IV classification attributed to Entry Tracking Forms followed
by a Discharge assessment for accuracy of the discharge status (A2100).
•
Missing or corrected (if applicable) assessments that have been transmitted
and accepted after the cut-off date(s) will not be reflected on the TimeWeighted CMI Resident Roster Report (both preliminary and final).
•
Review for missing or corrected (if applicable) assessments that may have
been transmitted and not accepted by the QIES ASAP system.
•
Review errors; make corrections and retransmit, if applicable.
•
Review for accuracy of dates and/or reasons for assessment by following the
RAI manual instructions for modifications and inactivation in Chapter 5.
•
Review the type of Entry tracking record (A1700=1 [admission] or A1700=2
[reentry]) to ensure that the reason fits the sequence of records displayed.
•
Any corrections including transmissions must be completed by the
predetermined cutoff date for the quarter.
RESIDENT ROSTER CMI CALCULATION
•
The day weighted calculations are completed for the facility on the last
page of the Resident Roster. The CMI averages are calculated for
Medicaid, Medicare, Other and All Residents.
•
The calculated days from the detail pages of the Resident Roster for each
source of payment are summed by RUG-IV classification.
•
For each RUG-IV classification, the assigned CMI is multiplied by the total
number of days to arrive at CMI points.
•
The sum of all of the CMI points divided by the sum of all days is the day
weighted average for the payment source.
•
The Final Resident Roster CMI averages are used in the determination of
the facility’s case mix rate.
CONTACT INFORMATION
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Jan Courtney
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Phone: 1-800-263-5339
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Email: Janc@mslc.com