OverviewThe Department of Social Services (DSS) will be transitioning Medicaid nursing facility reimbursement from a cost-based methodology to a case mix payment system. This method will aid DSS in its goals of enabling a meaningful continuum of long-term services and supports, modernizing Medicaid reimbursement, aligning payment with the acuity of residents, and preparing providers for value-based payment approaches. Please visit this web page often for updates regarding the transition to case mix reimbursement.
Connecticut General Statute Section § 17b-340d. Acuity-based methodology for Medicaid reimbursement of nursing home services. Regulations.
(a) The Commissioner of Social Services may implement an acuity-based methodology for Medicaid reimbursement of nursing home services. In the course of developing such a system, the commissioner shall review the skilled nursing facility prospective payment system developed by the Centers for Medicare and Medicaid Services, as well as other methodologies used nationally, and shall consider recommendations from the nursing home industry.
(b) The Commissioner of Social Services may implement policies as necessary to carry out the provisions of this section while in the process of adopting the policies as regulations, provided that prior to implementation the policies are posted on the eRegulations System established pursuant to section 4-173b and the Department of Social Services' Internet web site.
Reimbursement Modernization Updates:
September 29, 2021 - Case Mix Phase-In
Please download and review the presentation. Nursing homes may send questions to the Department directly, or to their Myers & Stauffer representative, or through the associations. Questions will be collected and an FAQ document will be published. Please submit questions by October 15, 2021. Questions to the Department can be sent to: email@example.com
Each nursing home will receive a rate sheet via their Myers & Stauffer portal account. The rate sheet will feature "shadow rates" and the calculation used to develop the shadow rate. The rate sheet will be published quarterly so each nursing home can understand the quarterly movement of the acuity system. As a reminder, shadow rates are not what the home will receive for reimbursement. The shadow rate is to assist homes in understanding the quarterly movement of an acuity system and to assist homes in preparation for the transition to acuity reimbursement.
Beginning October 1, 2021, and quarterly thereafter, DSS will notify homes of the expected home-by-home impact of the transition to an acuity based reimbursement. The home-by-home impact will be for informational purposes only and will not replace the rate in effect for 7/1/2021. Rate adjustments associated with acuity and associated quality metrics will be in effect starting rate period July 1, 2022.
The Department will hold town-hall meetings and informational sessions closer to October 2021. Please keep checking this webpage for meeting notices and for additional information. Meeting information will also be messaged through Myers and Stauffer LLC so nursing homes are encouraged to check their Myers and Stauffer account portals as well as this webpage.
March 19, 2021
Representatives from Myers and Stauffer LLC presented a webinar on the Case Mix System. Download the presentation.
September 30, 2020 - In late August, the Department shared with both nursing home associations that Connecticut will move forward with the CMS identified option to begin requiring and collecting additional fields for the Minimum Data Set (MDS) 3.0 item sets (version 1.17.2), with the purpose of categorizing OBRA MDS assessment submissions within the Patient-Driven Payment Model (PDPM) resident classification system.
Effective October 1, 2020, this change will allow Connecticut to collect PDPM payment codes and compare them to the RUG IV classification system. Additional MDS item set fields located in Sections GG, I, and J will support the PDPM payment codes. The Department is aware that certain software vendors have made updates to accommodate this change. We are also notifying all MDS software vendors used by Connecticut nursing facilities of which the Department is aware.
This is a necessary component of DSS' planned transition to a Medicaid acuity based payment system (case mix) in Connecticut, implementation of which has been delayed and no decision or date has been determined for the implementation of acuity based payment. We will notify facilities once information is available.
Collection of additional fields for the Minimum Data Set (MDS) 3.0 It will also help in evaluating PDPM classification and its viability as an alternative to the RUG IV system as the basis for case mix reimbursement. DPH plans will send additional information regarding PDPM on OBRA assessments beginning October 1, 2020 with a notation regarding training for the month of October. To help prepare nursing homes, please download the summary slide deck from Myers and Stauffer, LLC with useful information and background.
Additional information is available at the CMS website.
February 6, 2020 - Committees of Cognizance Nursing Home Forum: Modernization of Connecticut Medicaid Nursing Facility Reimbursement: An Essential Component of Long-Term Services and Supports "Rebalancing" Download the presentation
January 31, 2020 - Myers & Stauffer provided a an update on resident roster report processing. Download the presentation.
January 10, 2020 - Myers & Stauffer provided a brief overview of acuity based reimbursement methodology to the Medical Assistance Program Oversight Council (MAPOC). Download the presentation
Resident rosters training took place to give providers the tools needed to access the web portal. Please visit the Provider Resource section for user guides and additional information.
November 22, 2019
On November 22, 2019 at 2:00 p.m. the Department hosted a webinar presentation on the components of the Case Mix Index (CMI). The CMI is a weight assigned to a specific Resource Utilization Group (RUG) which reflects the diversity, clinical complexity, and resource needs of all residents within a nursing facility. An FAQ will be created shortly and posted to this page. Questions and comments may be sent to: firstname.lastname@example.org
Download the CMI presentation
October 4, 2019
Accurate Minimum Data Set (MDS) assessment data is essential in implementing a case mix reimbursement system. Access to and use of MDS data is controlled by the Centers for Medicare and Medicaid Services (CMS) through data use agreements. Myers and Stauffer obtained permission through such an agreement to use the data to assist the State in the development, implementation and on-going operation of the reimbursement system.
To facilitate this process, Case Mix Index (CMI) reports will be posted to a secure MDS web portal hosted by Myers and Stauffer. To ensure access to CMI Reports, nursing facilities are asked to please complete the form below and return to Myers and Stauffers no later than October 18, 2019. Additional information is available in the provider announcement below.
September 3, 2019
On Tuesday, September 3, 2019 the Department hosted a public meeting to discuss plans for implementation of a Case Mix Reimbursement System.
View the presentation
Frequently Asked Questions (revision issued November 12, 2019)
CMS finalized a new Medicare case-mix classification model, the Patient Driven Payment Model (PDPM). The CMS PDPM web-site includes a variety of educational and training resources to assist in understanding the Medicare PDPM method.
August 28, 2018
The Connecticut Department of Social Services (DSS) contracted with Myers and Stauffer LLC (MSLC) for consulting services to assist in transitioning Connecticut's Medicaid nursing facility reimbursement system from a cost-based methodology to a prospective acuity-based or case mix, payment system. MSLC will assist DSS with the design, development, implementation, and ongoing operational activities relating to a case mix reimbursement system.