Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1187 - NURSING FACILITY SERVICES
Subchapter G - RATE SETTING
Section 1187.93 - CMI calculations
Current through Register Vol. 54, No. 12, March 23, 2024
The Pennsylvania Case-Mix Payment System uses the following CMI calculations:
(1) An individual resident's CMI shall be assigned to the resident according to the RUG-III classification system.
(2) The facility MA CMI shall be the arithmetic mean of the individual CMIs for MA residents identified on the nursing facility's CMI report for the picture date. The facility MA CMI shall be used for rate determination under § 1187.96(a)(5) (relating to price and rate-setting computations.) If there are no MA residents identified on the CMI report for a picture date, the Statewide average MA CMI shall be substituted for rate determination under § 1187.96(a)(5).
(3) The total facility CMI is the arithmetic mean of the individual resident CMIs for all residents, regardless of payor, identified on the nursing facility's CMI report for the picture date. The total facility CMI for the February 1 picture date shall be used for price and rate setting computations as specified in § 1187.96(a)(1)(i).
(4) Picture dates that are used for rate setting beginning July 1, 2010, and thereafter will be calculated based on the RUG versions and CMIs set forth in Appendix A.
The provisions of this § 1187.93 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S. §§ 201(2), 206(2), 403(b) and 443.1(5)).
This section cited in 55 Pa. Code § 1187.96 (relating to price- and rate-setting computations).
