RSS FeedOffice of Long Term Living announces RUG-III version 5.12 proceeds with February Picture Date
Ruth Anne Barnard from the Office of Long Term Living sent an email response outlining the details of the move toward the use of the RUG-III version 5.12.
In Ruth Anne's email response it stated;
The following will be added to the Nursing Facility Q & A’s that are posted on our Website at: http://www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/LTCCaseMixInfo/
The Department is planning to make changes to our current nursing facility rate setting regulations and to our State Medicaid Plan, both to be effective July 1, 2010. The proposed changes would include a change to our RUG Grouper from the current RUG version 5.01-44 to the 5.12-34 version, and to begin using the latest assessments of any type during the Picture Dates that are used in our rate setting process. The Picture Dates that will be used in the July 1, 2010 rate setting process includes the February 1, 2010 Picture Date as well as the February 1 Picture Dates from all of the cost report periods of the Medicaid cost reports used in the July 1, 2010 rate setting database.
In that we plan on “Normalizing” the CMS-published set of CMI’s to be Pennsylvania Specific by using the February 1, 2010 Picture Date MDS’s, we are not yet able to provide the “PA Normalized” CMI set to be used in rate setting beginning July 1, 2010.
Before we can provide the PA Normalized CMI values to be used in the July 1, 2010 rate setting all of the appropriate MDS’s of the February 1, 2010 Picture date will have to be run through the RUG 5.12-34 grouper. A statewide average case mix index must be calculated using the CMS published CMI set, and then if the statewide average CMI does not equal 1.0, then the CMS-published CMIs will be adjusted upward or downward so that the statewide average CMI equals 1.0. That “PA Normalized” set of CMIs will be used in the July 1, 2010 rate setting, and in the rate setting process for some time thereafter.
At this point in time, we do not plan on using any CMI scores generated by using the RUG 5.01-44 grouper after the April 1, 2010 rate setting process, which uses the Medicaid CMI scores from the November 1, 2009 Picture Date
However, during the transition period, while we are waiting for approval of our State Plan Amendment from CMS and waiting for the regulations to be finalized, it is likely each facility will receive two CMI Reports:
- One CMI report using the current 5.01-44 grouper and the latest “comprehensive” assessments that may need to be used for retroactive rate setting if the anticipated changes are not approved.
- One CMI report using the 5.12 grouper and the latest assessment of any type and identifying the “ranking” of each resident in the 5.12 grouper hierarchy, from 1 to 34.
After the close of the February 1, 2010 Picture Date the identified resident assessments from the 5.12 grouper/latest assessment CMI report will be used to create the normalized CMI set for 5.12 for Pennsylvania. Another CMI report based upon the 5.12 grouper and latest assessment will then be issued showing the “normalized” MA CMIs and the Total facility average CMIs. This report will be used for the July 2010 rates, if the regulations and State Plan changes are approved.
We understand the difficulty for providers and software vendors during this transition period, but until the changes are approved a dual CMI Report processing will likely have to continue.