RUGs-Based Payment Update

The Department of Medical Assistance Services (DMAS) is evaluating whether or not to eliminate the quarterly Resource Utilization Group (RUG)/Case Mix Index (CMI) report and research process.  Under cost-based reimbursement, the quarterly report was utilized to identify the residents who should be included in the calculation of the case-mix neutralization and adjustment factors used in cost settlement/rate setting and rebasing.  DMAS does not believe these processes are necessary going forward, as payments are now adjusted for the RUGs score submitted on the claim.  DMAS has announced (vie GoFileRoom) that they have suspended the RUGs research process effective November 18, 2014 while they evaluate the future need of the process.  

For the next scheduled rebasing (rates effective for State Fiscal Year 2018), DMAS plans to calculate the case mix neutralization and/or adjustment scores in base years prior to the implementation of price-based from MDS data matched to nursing facility claims.  For subsequent rebasings, DMAS would calculate case mix scores from the RUG codes submitted on nursing facility claims.

DMAS is requesting feedback on eliminating both the research and the reporting process, and would like that feedback by next Wednesday, November 26th.  If you have any comments/concerns, please email Steve Ford.