In 2021, the Iowa Legislature directed Iowa Medicaid to evaluate the technical aspects of the case mix reimbursement system and rebasing processes.
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.
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:
rates semi-annually using a day-weighted average Medicaid CMI effective July 1,
Medicaid issuing rates as review of cost reports for individual providers are
completed, rather than waiting for all cost report reviews to be completed.
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
sessions will include:
methodology used for case mix classification
purpose of the case mix roster
to read the case mix roster
of preliminary rosters
of payer source
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.