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Colorado began PDPM data collection with the 07.01.2023 snapshot date. Every CMI correctible listing that will be posted and available after 04.01.2023 will only contain PDPM CMI scores.
State announced in April they are requiring the OSA to continue their RUG-IV model. An OSA will need to be performed on all federally required assessments that would be able to generate a RUG for current reimbursement to continue to collect all necessary data.
Historic Medicaid Acuity Model
RUG-IV 48 time-weighted
PDPM Capture Start
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
PDPM Rates Effective
We have not received any official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments.
Reimbursement Model Transition Updates
With requiring the OSA the state will be able to continue ahead with their current RUG-IV reimbursement model roll out timeline.
State has been providing shadow rates for PDPM rates since the 07.01.2023 rate release. The 9/30/23 snapshot CMI data will be frozen until the 03.31.2024 snapshot which will be used to determine reimbursement rates for 07.01.2024.
01.01.2024 (using PDPM data from 05.01.2023 and 08.01.2023 snapshots)
Reimbursement Model Transition Updates
The state will use PDPM data that was collected during the 05.01.2023 and the 08.01.2023 snapshot periods to establish rates for 01.01.2024. The rates will be adjusted every six months with new PDPM case mix information from alternating snapshot periods.
At an undetermined future date when the state has sufficient data and time to model rates using PDPM. State to continue modeling through state fiscal year 2023.
Reimbursement Model Transition Updates
A provider letter was sent on 03.24.2023 indicating required OSA use starts on 10.01.2023 for all federally required assessments. Failure to complete an OSA with the same ARD as a federally required assessment will prevent the state from being able to calculate a RUG and will result in the record being assigned to the delinquent BC1 category.
The transition to a Nursing CMG PDPM payment model will finish for the 10.01.2023 rate calculation with only using PDPM data from the 06.30.2023 snapshot.
No decision by the Office of Medicaid Policy and Planning had been made as of May 2023 per the Myers and Stauffer transition FAQ with new new infromation in Myers and Stauffer’s newsletters for Case Mix in Indiana.
Rates Effective
No decision by the Office of Medicaid Policy and Planning had been made as of May 2023 per the Myers and Stauffer transition FAQ with new new information in Myers and Stauffer’s newsletters for Case Mix in Indiana.
Reimbursement Model Transition Updates
OSA use starts on 10.01.2023 for all federally required assessments where a RUG would currently be established.
Facilities began collecting only PDPM data for time weighted rosters on 07.01.2023 which included assessments completed prior to that quarter. In conjunction with the change to PDPM the state is moving to six month CMI capture period for biannual rate adjustments instead of quarterly.
10.01.2023 will be the last snapshot where RUG data is used which will be used for setting the 01.01.2024 rates. If the state proceeds as planned without requiring an Optional State Assessment (OSA) beginning 10.01.2023, then they will not be able to determine a RUG classification for assessments completed on 10.01.2023 or after. So if any assessments completed on the 10.01.2023 picture date will not be included in the facility average unless another accommodation is made to be able to capture that RUG data. However as of 07.11.2023, the State has not made a final decision regarding transitioning from RUG to PDPM.
Q3 2023 patient RUG data collection will be used to establish rates for 01.01.2024 which will be frozen throughout the 04.01.2024 rate period until 07.01.2024 when Q1 2024 PDPM data capture will determine rates.
An OSA will need to be completed with the same ARD as all OBRA assessments used for payment purposes.
Historic Medicaid Acuity Model
RUG-III 44
PDPM Capture Start
Uknown
PDPM Rates Effective
Uknown
Reimbursement Model Transition Updates
Maine is requiring the OSA be performed in conjunction with all assessments used for payment purposes starting on 10.01.2023 to continue the existing RUG III reimbursement model. The state has not yet finalized any plans for a changed payment mode.
Frozen RUG-IV 48 Rates until 07.01.2024 Time-Weighted data collection
OSA Use - Not Required
Historic Medicaid Acuity Model
RUG-IV 48 time-weighted
PDPM Capture Start
07.01.2024
PDPM Rates Effective
07.01.2025
Reimbursement Model Transition Updates
State initial PDPM implementation plan was postponed and then changed to using a 07.01.2024 PDPM data capture to establish 01.01.2025 rates. For rates up until 12.31.2024 they will be freezing the last or last several quarters’ CMI scores.
The state defined active assessment on 10.01.2023 will determine the residents active payment level until the next active assessment is completed. MMQs will still need to be completed for any billable dates prior to 10.01.2023, but not for any after. There will be 25 PDPM Nursing CMG categories.
MDS RUG data through 09.30.2023 will be used for establishing Medicaid rates until 06.30.2024. The reimbursement model for 07.01.2024 will be determined after the annual rate review process that will occur in the Spring of 2024, a PDPM model will be considered as the a potential future reimbursement model at that time.
Capture Model on 10.01.2023 - Undefined PDPM Model
OSA Use - Not Antcipated
Historic Medicaid Acuity Model
RUG-III 34 snapshot
PDPM Capture Start
As early as 10.01.2023
PDPM Rates Effective
07.01.2024
Reimbursement Model Transition Updates
State is in the final planning stages of a transition to a PDPM reimbursement model using Nursing CMGs, but there is discussion about including other PDPM CMGs into the final model.
Frozen RUG-III rates from 04.01.2023 to 09.30.2023 data collection period.
OSA Use - Not Required
Historic Medicaid Acuity Model
RUG-III 53 six month average
PDPM Capture Start
At future date
PDPM Rates Effective
At future date
Reimbursement Model Transition Updates
Freezing RUG CMI average from 04.01.2023 to 09.30.2023 for use with future rate periods. State is still in the initial planning stages of move to a PDPM reimbursement model.
An OSA will need to be completed with the same ARD as all federally required assessments starting 10.01.2023 until the planned change in reimbursement model no later than 10.01.2025.
Historic Medicaid Acuity Model
RUG-III 34 time-weighted
PDPM Capture Start
No later than 10.01.2025
PDPM Rates Effective
No later than 04.01.2026
Reimbursement Model Transition Updates
OSA use starts on 10.01.2023 for all federally required assessments where a RUG would currently be established.
OSA USE - CONTINUE WITH CURRENT STATE REQUIREMENTS
Historic Medicaid Acuity Model
RUG-IV 48
PDPM Capture Start
Unconfirmed
PDPM Rates Effective
Unconfirmed
Reimbursement Model Transition Updates
State has used only OSAs to determine state Medicaid RUG categories for individual resident payment rates. This model will continue to be supported by CMS until 09.30.2025.
Providers have the choice to freeze their 03.31.2023 CMI score for SFY 2024 and 2025 or continue with current RUGs reimbursement model using OSA. Providers must notify the state of their decision by 10.01.2023 deadline. The Ohio Department of Medicaid is working to create an online reporting tool that would allow providers to submit their choice. Once the choice has been made there is no statutory option for a reconsideration during the biennium. If the CMI score is chosen to be frozen any Medicaid resident that grouped into PA1-2 in the March 2023 quarterly report will remain at that level for the biennium. Ohio indicated in their April training that if they go to a PDPM reimbursement model that they would use the Nursing CMG to establish scores.
An OSA will need to be completed with the same ARD as all federally required PPS and OBRA assessments starting 10.01.2023. An OSA will not be needed for discharge assessments.
Historic Medicaid Acuity Model
RUG-III 44 snapshot
PDPM Capture Start
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
PDPM Rates Effective
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
An OSA will need to be completed with the same ARD as all federally required assessments starting 10.01.2023 until the planned change in reimbursement model on 10.01.2025.
Historic Medicaid Acuity Model
RUG-IV 48
PDPM Capture Start
10.01.2025 (anticipated)
PDPM Rates Effective
10.01.2025 (anticipated)
Reimbursement Model Transition Updates
OSA use for 10.01.2023 through 09.30.2025 for all federally required assessments with a planned change to a PDPM model on 10.01.2025.
The state is requiring that an additional 55 fields be entered into the LTC portal for the LTCMI that were previously autofilled by the corresponding MDS submitted MDS assessment for that ARD to be able to continue to collect RUG data.
For assessments with an ARD on or after 10.01.2023, and until a rebase of reimbursement rates occurs that incorporates a PDPM resident classification methodology, an OSA with the same ARD will need to be completed in conjunction with it.
Historic Medicaid Acuity Model
RUG-III 29
PDPM Capture Start
Unconfirmed
PDPM Rates Effective
Following a period where data can be collected for rebasing facility rates.
