AGING AND DISABILITY SERVICES ADMINISTRATION
Case Mix for Washington State Medicaid Nursing Home Payment
What actually is Case Mix?
The term "case" refers to the residents. The term “mix” refers to differences or variety. Therefore, "Case Mix" describes differences in residents within a population in terms of their physical and mental conditions, and the resources that are used in their care. Case Mix reimbursement systems measure the intensity of care and services required for each resident and translate those measures into groupings. Those groupings are used in the calculation of facility payment.
State of Washington Contacts
- Analyst, Payments & Research Section Allen Miller 360-725-2475 MilleAM@dshs.wa.gov
- RAI Coordinator and Case Mix Accuracy Review Program Manager Marge Ray 360-725-2487 RayMA@dshs.wa.gov
- MDS Automation Coordinator Shirley Stirling 360-725-2620 StirLSA@dshs.wa.gov
State Law and WA Admin Code
Note: Several of these documents are in Word or PDF format. Free viewers for these documents can be found here.
- RCW 74.46.506 - Direct Care Rate Allocation – Determinations – Quarterly Updates - Fines
- RCW 74.46.485 - Case mix classification methodology.
- RCW 74.46.501 - Quarterly Average case mix indexes – Facility and Medicaid
- WAC 388-96 – NH Medicaid payment system
- WAC 388-96-738 - Default case mix group and weight when there is no MDS assessment
- WAC 388-96-905 - Case mix accuracy review of MDS nursing facility resident assessments
- WAC 388-96-904 - Administrative Review
- WAC 388-96-901 - Disputes
Business Rules
Case Mix Weights
- Adequacy of Case Mix in Determining NH Payments, Report to the Legislature, 2002 (PDF)
- Historical Case Mix Weights in Washington State (Word)
- Current Case Mix Weights in Washington State (Word)
- 3rd Qtr 2009 Facility CMI (Preliminary)
Accuracy Review
- Case Mix Accuracy Review (CMAR) (Word)
- 2004 Best Practices in Accuracy Review of Case-Mix Items (Word)
Discharge and Re-entry Tracking
RUG Reports
Fixing Errors
- Default Primer
- Duplicate Residents (Word)
- Error Correction and Duplicate Resident
- MDS Correction Policy (PDF)
MDS Clinical
MDS Automation
- Automation
- Default Primer (PDF)
