Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
The afternoon of Wednesday, March 23, 2022, the Iowa Department of Human Services posted INFORMATIONAL LETTER NO. 2326-MC-FFS. The subject is: NF Day-Weighted Case Mix Index (CMI) Methodology.
In 2021, the Iowa Legislature directed Iowa Medicaid to evaluate the technical aspects of the case mix reimbursement system and rebasing processes. A workgroup was established in July 2021, to review existing processes and identify mechanisms to reduce or eliminate retrospective payments during the bi-annual nursing facility rebasing process. The workgroup identified and evaluated pros and cons associated with each of these components. That information was utilized to develop comprehensive recommendations to improve the nursing facility rate setting and payment process.
The budget-neutral changes will help to modernize the case mix system and increase efficiencies in the rebasing processes. The updates will assist in stabilizing swings in nursing facility rates and significantly reduce impacts of retrospective rates. The changes include:
• Updating rates semi-annually using a day-weighted average Medicaid CMI effective July 1, 2023.
• Iowa Medicaid issuing rates as review of cost reports for individual providers are completed, rather than waiting for all cost report reviews to be completed.
Iowa Medicaid will conduct virtual provider training sessions regarding the NF day-weighted CMI methodology via Zoom. The Zoom training will be conducted monthly from March through December 2022, to allow providers the opportunity to attend one or multiple training sessions.
Training sessions will cover:
• methodology used for case mix classification
• purpose of the case mix roster
• how to read the case mix roster
• review of preliminary rosters
• general calculation guidelines
• determination of payer source
A frequently-asked question (FAQ) document will be developed from questions received during the live presentation. The FAQ document and PowerPoint materials will be posted on the DHS website at a later date.
To register for this training session, please complete the registration form found here. Zoom meeting login credentials will be sent to the email address provided on the registration form.
Questions regarding this training opportunity should be directed to Iowa Medicaid at firstname.lastname@example.org.