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

Universal Citation: 101 MA Code of Regs 101.206

Current through Register 1531, September 27, 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.

(2) Operating Cost Standard Payments. Effective October 1, 2023, nursing facilities will receive operating cost standard payments of $123.83.

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