During the Zimmet Conference “Lights, Camera, Reimbursement,” Sally Fecto from Zimmet and Margaret Kirby from National Healthcare Associates led an informative roundtable group on Connecticut’s move to case-mix reimbursement for Medicaid.

The system was enabled 5 years ago but full implementation was delayed until July 1, 2022, mostly due to the pandemic. 

SNFs have been using a “shadow system” where they gather, submit, and receive rates.  However, those rates have not yet been used for payment.  Like other case-mix systems, some providers will be above the average, and some will be below. These “stop-gains” and “stop-losses” will disappear after 3 years.    An official audit was performed by a reputable accounting firm.  The results are expected to be published soon.

Fecto & Kirby fluently discussed proven strategies for CMI success with the audience. These include proactive management of ADLs, mood, cognition, ARD management, and having productive CMI meetings.  They consider the day-weighted system to be the “most fair of the CMI methodologies

 Some of the key takeaways were:

  1. Make sure that you know the CMI RUG Qualifiers for Connecticut
  2. Know the value of extensive services when it comes to the overall facility CMI
  3. Be able to predict the CMI RUG Score before completion of the OBRA assessment
  4. MDSCs should be able to in-service individual staff members on ADLs on a regular basis
  5. An accurate MDS should tell the clinical story of the resident
  6. There are five (5) rehab scores in the system

Connecticut SNF providers will soon learn that those with successful case mix systems adopt a “24/7/365” approach. In case-mix, SNFs compete for the same Medicaid dollar from the same pool of money.  Nursing home speech therapy frequently works with the long-term care population on conditions like dysphagia and impaired cognition. Therefore, a great speech therapy department can be an unsung hero to their SNF’s CMI.  Contact Language Fundamentals today if you’d like to learn more about bringing your speech department to the next level.