House Journal: Page 1689: Tuesday, May 1, 2001
25 d. (1) The department of human services shall use
26 the resource utilization groups-III (RUG-III), version
27 5.12b, 34 group, index maximizer model as the resident
28 classification system to determine a nursing
29 facility's case-mix index, based on data from the
30 minimum data set (MDS) submitted by each facility.
31 Standard version 5.12b, 34 group case-mix indices,
32 developed by HCFA, shall be the basis for calculating
33 the average case-mix index and shall be used to adjust
34 the direct-care component in the determination of the
35 modified price-based case-mix reimbursement rate.
36 (2) The department of human services shall
37 determine and adjust each facility's case-mix index on
38 a quarterly basis. A separate calculation shall be
39 made to determine the average case-mix index for a
40 facilitywide case-mix index, and a case-mix index for
41 the medical assistance residents of the nursing
42 facility using the minimum data set (MDS) report
43 submitted by the facility for the previous quarter,
44 which reflects the residents in the facility on the
45 last day of the previous calendar quarter.
46 e. The department shall calculate the rate ceiling
47 for the direct-care cost component at 110 percent of
48 the median of case-mix adjusted costs. Nursing
49 facilities with direct care case-mix adjusted costs at
50 100 percent of the median or greater, shall receive an
Page 3
1 amount equal to their costs not to exceed 110 percent
2 of the median. Nursing facilities with case-mix
3 adjusted costs below 100 percent of the median shall
4 receive a profit add-on payment by having their
5 payment rate for the direct-care cost component
6 calculated as their allowable case-mix adjusted cost
7 plus 50 percent of the difference between 100 percent
8 of the median and their allowable case-mix adjusted
9 cost, not to exceed 10 percent of the median of case-
10 mix adjusted costs.
11 f. The department shall calculate the rate ceiling
12 for the nondirect care cost component at 100 percent
13 of the median of non-case-mix adjusted costs. Nursing
14 facilities with non-case-mix adjusted costs at 95
15 percent of the median or greater shall receive an
16 amount equal to their costs not to exceed 100 percent
17 of the median. Nursing facilities with non-case-mix
18 adjusted costs below 95 percent of the median shall
19 receive a profit add-on payment that is their costs
20 plus 50 percent of the difference between 95 percent
21 of the median and their non-case-mix adjusted costs,
22 not to exceed 15 percent of the median of non-case-mix
23 adjusted costs.
© 2001 Cornell College and
League of Women Voters of Iowa
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