The Connecticut Department of Social Services will be transitioning Medicaid nursing facility reimbursement from a cost-based methodology to a prospective acuity-based or case mix payment system. This method will aid DSS in its goals of moving toward a system that is data driven, improves transparency, and benefits patient outcomes. Below is information regarding the implementation of the Medicaid acuity-based reimbursement system. Please check this web page often for the most current information.
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.
In July 2018, CMS finalized a new Medicare case-mix classification model, the Patient Driven Payment Model (PDPM) effective beginning October 1, 2019. The CMS PDPM website includes a variety of educational and training resources to assist in understanding the Medicare PDPM method.
Medicaid Acuity-Based Methodology Timeline and Updates
August 28, 2018
The Connecticut Department of Social Services (DSS) will be contracting 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.