Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.04 - Nursing Standard Payments and Operating Cost Standard Payments

Current through Register 1525, July 5, 2024
(1)
Nursing Standard
			 Payments
.
(a)
Nursing Standard Payment Calculation
. Effective
			 October 1, 2023, nursing facilities will receive the following nursing standard
			 payments:
PDPM Nursing HIPPS Code (Acuity
							 Level)
PDPM Nursing Case Mix Index (2022)
Nursing Standard Payment
A (ES3)
3.95
$ 390.73
B (ES2)
2.99
$ 295.77
C (ES1)
2.85
$ 281.92
D (HDE2)
2.33
$ 230.48
E (HDE1)
1.94
$ 191.90
F (HBC2)
2.18
$ 215.65
G (HBC1)
1.81
$ 179.05
H (LDE2)
2.02
$ 199.82
I (LDE1)
1.68
$ 166.19
J (LBC2)
1.67
$ 165.20
K (LBC1)
1.39
$ 137.50
L (CDE2)
1.82
$ 180.03
M (CDE1)
1.58
$ 156.29
N (CBC2)
1.51
$ 149.37
O (CA2)
1.06
$ 104.86
P (CBC1)
1.30
$ 128.60
Q (CA1)
0.91
$ 90.02
R (BAB2)
1.01
$ 99.91
S (BAB1)
0.96
$ 94.96
T (PDE2)
1.53
$ 151.35
U (PDE1)
1.43
$ 141.46
V (PBC2)
1.19
$ 117.71
W (PA2)
0.69
$ 68.25
X (PBC1)
1.10
$ 108.81
Y (PA1)
0.64
$ 63.31
(b)
Nursing Standard Payment Adjustment
. Effective October
			 1, 2023, eligible nursing facilities will receive adjustments to their standard
			 nursing payments at
			 101
			 CMR 206.04(1)(a), which will
			 be calculated and determined as follows.
1.
			 Calculate each facility's average nursing rate in effect as of September 30,
			 2023, weighted by the facility's Management Minute Questionnaire (MMQ) case mix
			 during the period of rate year 2022.
2. Calculate each facility's average proposed
			 nursing rate, to be effective October 1, 2023, using the nursing rates as
			 defined in
			 101
			 CMR 206.04(1)(a)  and
			 weighted by the facility's average PDPM nursing case mix index during the
			 period of calendar year 2022.
3. To
			 determine a facility's eligibility for the Nursing Payment Adjustment
a. First, determine whether the facility is a
			 pediatric facility. If the facility is a pediatric facility, then
i. Determine whether the value calculated in
			 101
			 CMR 206.04(1)(b)2. is less
			 than the value calculated in
			 101
			 CMR 206.04(1)(b)1.
ii. If the value calculated in
			 101
			 CMR 206.04(1)(b)2. is less
			 than the value calculated in 206.04(1)(b)1., then calculate an "average nursing
			 rate adjustment" such that the sum of this adjustment and the value calculated
			 in 101 CMR
			 206.04(1)(b)2. will be equal
			 to the value calculated in
			 101
			 CMR 206.04(1)(b)1.
iii.  Divide the "average nursing
			 rate adjustment" by the value calculated in
			 101
			 CMR 206.04(1)(b)2. The
			 resulting percentage, rounded to the nearest hundredth of a percent, will be
			 the Nursing Payment Adjustment.
b. If the facility is not a pediatric
			 facility, then determine whether the facility is a high Medicaid facility. For
			 the purposes of the Nursing Payment Adjustment, a high Medicaid facility is
			 defined as a facility for which Massachusetts Medicaid days are at least 75.00%
			 of its total resident days, as reported on quarterly User Fee Assessment Forms
			 for the period July 1, 2022, through June 30, 2023. If the facility is a high
			 Medicaid facility, then
i. Determine whether
			 the value calculated in
			 101
			 CMR 206.04(1)(b)2. is less
			 than 98.5% of the value calculated in
			 101
			 CMR 206.04(1)(b)1.
ii. If the value calculated in
			 101
			 CMR 206.04(1)(b)2. is less
			 than 98.5% of the value calculated in
			 101
			 CMR 206.04(1)(b)1., then
			 calculate an "average nursing rate adjustment" such that the sum of this
			 adjustment and the value calculated in
			 101
			 CMR 206.04(1)(b)2. will be
			 equal to 98.5% of the value calculated in
			 101
			 CMR 206.04(1)(b)1.
iii. Divide the "average nursing rate
			 adjustment" by the value calculated in
			 101
			 CMR 206.04(1)(b)2. The
			 resulting percentage, rounded to the nearest hundredth of a percent, will be
			 the Nursing Payment Adjustment.
4. For eligible facilities, the Nursing
			 Payment Adjustment will be calculated as an adjustment to the nursing standard
			 rate, applied at each PDPM nursing case mix category.