MDS Alert
Check Out The Case-Mix States
Three have case-mix systems of a different feather. You have more than a 50 percent chance of being in a Medicaid case-mix state -- and those odds will likely grow as more states adopt this reimbursement approach. Colorado
There are about 26 states that use MDS-based RUG-III case-mix systems, according to Carol Job, RN, board chair for the American Association of Nurse Assessment Coordinators and a consultant with Myers & Stauffer in Topeka, KS. "Most of the Medicaid states use RUG-34 versus 53," she adds.
3 Case-Mix States of a Different Feather
New York uses RUG-II and the Patient Review Instrument, although the state is in a two-year transition to the RUG-III, which is the MDS system, says Patrick Cucinelli, financial policy analyst for the New York Association of Homes & Services for the Aging.
Texas currently uses the TILE system, which is based "roughly" on an earlier version of the RUG system, says Tom Plowman, spokesman for the Texas Health Care Association. But the "short answer" is that Texas is moving to an MDS-based RUG-III system. The state projects it may be in place by September 2008, he adds, "but we have a lot of work to do" to make that happen.
In addition, on Jan. 1, Illinois implemented an MDS-based reimbursement system to determine the nursing component of the facility's Medicaid rate, says Marilyn Mines, RN, RAC-C, BC, director of clinical services with FR&R Healthcare Consulting in Deerfield, IL. Fifty-one "reimbursable MDS items" are assigned minutes for one or more staff types, including unlicensed, licensed, social worker and activities, Mines explains.
"These reimbursable areas are very different than any RUG calculation for PPS or other state Medicaid systems," says Mines.
Following is the list of MDS/RUG-based case-mix states as of December 2006:
Georgia
Hawaii
Idaho
Iowa
Indiana
Kansas
Kentucky
Louisiana
Maine
Minnesota
Mississippi
Montana
Nebraska
Nevada
New Hampshire
North Carolina
North Dakota
Ohio
Pennsylvania
South Dakota
Utah
Vermont
Virginia
Washington
West Virginia
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