Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 45 - RATES FOR NURSING FACILITY SERVICES › Section 471-45-016 - CLASSIFICATION OF RESIDENTS AND CORRESPONDING WEIGHTS

Current through June 17, 2024
016.01
RESIDENT LEVEL OF CARE.
The Department will use a
  federally approved patient driven payment-model grouper to assign a level of
  care using the information from the minimum data set. Each level of care will
  be assigned the federally recommended weight. When no minimum data set
  assessment is available, the resident will be assigned to a default level of
  care, Level 280.
016.02
WEIGHTING OF RESIDENT DAYS USING RESIDENT LEVEL OF CARE AND
  WEIGHTS.
Each facility resident is assigned to a level of care.
  Each resident's level of care is appropriately updated from each assessment to
  the next admission assessment, a significant change assessment, the quarterly
  review, the annual assessment, etc., and is effective for payment purposes on
  the first day of the month of the applicable assessment if it is received by
  the tenth day of the month of the applicable assessment. A change in resident
  level of care which results from an audit of assessments is retroactive to the
  effective date of the assessment which is audited. For purposes of the Medicaid
  case mix system, the Department does not change an assessment record. A record
  modification may replace an existing record in the Centers for Medicare &
  Medicaid Services minimum data set data base, but the Department will not
  replace the existing record in the Medicaid case mix system. The record
  modification will be processed by the Department as an original record. This
  means that the Department will process the record in the usual manner if the
  record is not already in the case mix system. The Department will reject the
  record as a duplicate if the record has already been accepted into the case mix
  system. The Department will inactivate a discharge or re-entry tracking record
  but not an assessment. For each reporting period, the total resident days, per
  the minimum data set system, at each care level are multiplied by the
  corresponding weight. The resulting products are summed to determine the total
  weighted resident days per the minimum data set system. This total is then
  divided by the minimum data set total resident days per the minimum data set
  system. This total is then divided by the minimum data set total resident days
  and multiplied by total resident days per the facility's Medicaid cost report
  to determine the total number of weighted resident days for the facility, which
  is the divisor for the direct nursing component.
016.03
RESIDENT LEVEL OF CARE
  WEIGHTS.
The following weighting factors must be assigned to each
  resident level of care, based on the Centers for Medicare and Medicaid Services
  Patient Driven Payment Model Nursing classifications:
(A) Level of care: 272; Case Mix Group: ES3;
  Description: Extensive Services 3, Tracheostomy and Ventilator; Case Mix Index
  Value: 4.06;
(B) Level of care:
  271; Case Mix Group: ES2; Description: Extensive Services 2, Tracheostomy or
  Ventilator; Case Mix Index Value: 3.07;
(C) Level of care: 270; Case Mix Group: ES1;
  Description: Extensive Services 1, Infection Isolation; Case Mix Index Value:
  2.93;
(D) Level of care: 263; Case
  Mix Group: HDE2; Description: Special Care High, Depressed, Function Score 0-5;
  Case Mix Index Value: 2.40;
(E)
  Level of care: 262; Case Mix Group: HDE1; Description: Special Care High, Not
  Depressed, Function Score 0-5; Case Mix Index Value: 1.99;
(F) Level of care: 261; Case Mix Group: HBC2;
  Description: Special Care High, Depressed, Function Score 6-14; Case Mix Index
  Value: 2.24;
(G) Level of care:
  260; Case Mix Group: HBC1; Description: Special Care High, Not Depressed,
  Function Score 6-14; Case Mix Index Value: 1.86;
(H) Level of care: 253; Case Mix Group: LDE2;
  Description: Special Care Low, Depressed, Function Score 0-5; Case Mix Index
  Value: 2.08;
(I) Level of care:
  252; Case Mix Group: LDE1; Description: Special Care Low, Not Depressed,
  Function Score 0-5; Case Mix Index Value: 1.73;
(J) Level of care: 251; Case Mix Group: LBC2;
  Description: Special Care Low, Depressed, Function Score 6-14; Case Mix Index
  Value: 1.72;
(K) Level of care: 250;
  Case Mix Group: LBC1; Description: Special Care Low, Not Depressed, Function
  Score 6-14; Case Mix Index Value: 1.43;
(L) Level of care: 245; Case Mix Group: CDE2;
  Description: Clinically Complex, Depressed, Function Score 0-5; Case Mix Index
  Value: 1.87;
(M) Level of care: 244;
  Case Mix Group: CDE1; Description: Clinically Complex, Not Depressed, Function
  Score 0-5; Case Mix Index Value: 1.62;
(N) Level of care: 243; Case Mix Group: CBC2;
  Description: Clinically Complex, Depressed, Function Score 6-14; Case Mix Index
  Value: 1.55;
(O) Level of care: 241;
  Case Mix Group: CA2; Description: Clinically Complex, Depressed, Function Score
  15-16; Case Mix Index Value: 1.09;
(P) Level of care: 242; Case Mix Group: CBC1;
  Description: Clinically Complex, Not Depressed, Function Score 6-14; Case Mix
  Index Value: 1.34;
(Q) Level of
  care: 240; Case Mix Group: CA1; Description: Clinically Complex, Not Depressed,
  Function Score 15-16; Case Mix Index Value: 0.94;
(R) Level of care: 221; Case Mix Group: BAB2;
  Description: Behavior SX Cognition, Restorative Nursing >= 2; Case Mix Index
  Value: 1.04;
(S) Level of care: 220;
  Case Mix Group: BAB1; Description: Behavior SX Cognition, Restorative Nursing =
  1 or 2; Case Mix Index Value: 0.99;
(T)
   Level of care: 206; Case Mix Group: PDE2; Description: Reduced
  Physical Function, Restorative Nursing >= 2, Function Score 0-5; Case Mix
  Index Value: 1.57;
(U) Level of
  care: 205; Case Mix Group: PDE1; Description: Reduced Physical Function,
  Restorative Nursing = 1 or 2, Function Score 0-5; Case Mix Index Value:
  1.47;
(V) Level of care: 204; Case
  Mix Group: PBC2; Description: Reduced Physical Function, Restorative Nursing
  >= 2, Function Score 6-14; Case Mix Index Value: 1.22;
(W) Level of care: 202; Case Mix Group: PA2;
  Description: Reduced Physical Function, Restorative Nursing >= 2, Function
  Score 15-16; Case Mix Index Value: 0.71;
(X) Level of care: 203; Case Mix Group: PBC1;
  Description: Reduced Physical Function, Restorative Nursing = 1 or 2, Function
  Score 6-14; Case Mix Index Value: 1.13;
(Y) Level of care: 201; Case Mix Group: PA1;
  Description: Reduced Physical Function, Restorative Nursing = 1 or 2, Function
  Score 15-16; Case Mix Index Value: 0.66; or
(Z) Level of care: 280; Casemix Index Vaue:
  STS; Casemix Index Description: Short-Term Stay; Casemix Index Value: 0.59;
  Level of Care 280, Short-Term Stay, is used for stays of less than 14 days when
  a client is discharged and the facility does not complete a full minimum data
  set admission assessment of the client. This is effective for admissions on or
  after July 1, 2023.