101 CMR, § 206.04 - Nursing Standard Payments and Operating Cost Standard Payments
(1)
Nursing Standard
Payments.
(a)
Nursing
Standard Payment Calculation. Beginning October 1, 2024, 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 |
$ 395.75 |
|
B (ES2) |
2.99 |
$ 299.57 |
|
C (ES1) |
2.85 |
$ 285.54 |
|
D (HDE2) |
2.33 |
$ 233.44 |
|
E (HDE1) |
1.94 |
$ 194.37 |
|
F (HBC2) |
2.18 |
$ 218.41 |
|
G (HBC1) |
1.81 |
$ 181.34 |
|
H (LDE2) |
2.02 |
$ 202.38 |
|
I (LDE1) |
1.68 |
$ 168.32 |
|
J (LBC2) |
1.67 |
$ 167.32 |
|
K (LBC1) |
1.39 |
$ 139.26 |
|
L (CDE2) |
1.82 |
$ 182.35 |
|
M (CDE1) |
1.58 |
$ 158.30 |
|
N (CBC2) |
1.51 |
$ 151.29 |
|
O (CA2) |
1.06 |
$ 106.20 |
|
P (CBC1) |
1.30 |
$ 130.25 |
|
Q (CA1) |
0.91 |
$ 91.17 |
|
R (BAB2) |
1.01 |
$ 101.19 |
|
S (BAB1) |
0.96 |
$ 96.18 |
|
T (PDE2) |
1.53 |
$ 153.29 |
|
U (PDE1) |
1.43 |
$ 143.27 |
|
V (PBC2) |
1.19 |
$ 119.23 |
|
W (PA2) |
0.69 |
$ 69.13 |
|
X (PBC1) |
1.10 |
$ 110.21 |
|
Y (PA1) |
0.64 |
$ 64.12 |
(b)
Nursing Standard Payment Adjustment. Beginning October
1, 2024, 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 standard payment rate in effect as of
September 30, 2024, weighted by the facility's average PDPM nursing case mix
during the period of October 1, 2023, through March 31, 2024. For each
facility, add this value to the facility's average Nursing Standard Payment
Adjustment in effect as of September 30, 2024, weighted by the facility's
average PDPM nursing case mix during the period of October 1, 2023, through
March 31, 2024.
2. Calculate each
facility's average proposed nursing standard payment rate, beginning October 1,
2024, using the nursing rates as defined in
101
CMR 206.04(1)(a) and
weighted by the facility's average PDPM nursing case mix during the period of
October 1, 2023, through March 31, 2024.
3. To determine a facility's eligibility for
the Nursing Standard 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 Standard 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 Standard 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 April 1, 2023, through March 31, 2024. 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 the value calculated in 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
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 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 Standard Payment Adjustment.
4. For eligible facilities, the Nursing
Standard Payment Adjustment will be applied as an upward adjustment to the
nursing standard payment rate at each PDPM nursing case mix category.
(2)
Operating Cost Standard Payments. Beginning October 1,
2024, nursing facilities will receive operating cost standard payments of
$125.41.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Nursing Standard Payments.
(a) Nursing Standard Payment Calculation. Beginning October 1, 2024, 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 | $ 395.75 |
| B (ES2) | 2.99 | $ 299.57 |
| C (ES1) | 2.85 | $ 285.54 |
| D (HDE2) | 2.33 | $ 233.44 |
| E (HDE1) | 1.94 | $ 194.37 |
| F (HBC2) | 2.18 | $ 218.41 |
| G (HBC1) | 1.81 | $ 181.34 |
| H (LDE2) | 2.02 | $ 202.38 |
| I (LDE1) | 1.68 | $ 168.32 |
| J (LBC2) | 1.67 | $ 167.32 |
| K (LBC1) | 1.39 | $ 139.26 |
| L (CDE2) | 1.82 | $ 182.35 |
| M (CDE1) | 1.58 | $ 158.30 |
| N (CBC2) | 1.51 | $ 151.29 |
| O (CA2) | 1.06 | $ 106.20 |
| P (CBC1) | 1.30 | $ 130.25 |
| Q (CA1) | 0.91 | $ 91.17 |
| R (BAB2) | 1.01 | $ 101.19 |
| S (BAB1) | 0.96 | $ 96.18 |
| T (PDE2) | 1.53 | $ 153.29 |
| U (PDE1) | 1.43 | $ 143.27 |
| V (PBC2) | 1.19 | $ 119.23 |
| W (PA2) | 0.69 | $ 69.13 |
| X (PBC1) | 1.10 | $ 110.21 |
| Y (PA1) | 0.64 | $ 64.12 |
(b) Nursing Standard Payment Adjustment. Beginning October 1, 2024, 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 standard payment rate in effect as of September 30, 2024, weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024. For each facility, add this value to the facility's average Nursing Standard Payment Adjustment in effect as of September 30, 2024, weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024.
2. Calculate each facility's average proposed nursing standard payment rate, beginning October 1, 2024, using the nursing rates as defined in 101 CMR 206.04(1)(a) and weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024.
3. To determine a facility's eligibility for the Nursing Standard 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 Standard 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 Standard 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 April 1, 2023, through March 31, 2024. 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 the value calculated in 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 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 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 Standard Payment Adjustment.
4. For eligible facilities, the Nursing Standard Payment Adjustment will be applied as an upward adjustment to the nursing standard payment rate at each PDPM nursing case mix category.
(2) Operating Cost Standard Payments. Beginning October 1, 2024, nursing facilities will receive operating cost standard payments of $125.41.