DMAS Eliminates RUG/Case Mix Reporting and Research Process

With the implementation of nursing facility price-based reimbursement, the Department of Medical Assistance Services (DMAS) announced that as of December 3rd, they have eliminated the quarterly Resource Utilization Group (RUG)/ Case Mix Index (CMI) report and research process.  Under cost-based reimbursement, this quarterly report was prescribed to identify the residents that should be included in the calculation of the case-mix neutralization and adjustment factors used in cost settlement/rate setting and rebasing.  These processes are no longer necessary under the new methodology – as you know, payments are now adjusted for the individual RUGS score submitted on a claim, as opposed to use of the old facility case mix adjustment.  

VHCA is pursuing discussion with DMAS around case mix data to be utilized in subsequent rebasing of rates (the next being for rates effective July 2017) in order to ensure our members have an opportunity to review/verify the data used in the rebasing calculations.  Further, we are discussing the possibility of RUGs distribution reports on both a regional and statewide basis going forward.  We will provide updates on these two discussions as they develop.