101 CMR 206.04 - Nursing Standard Payments and Operating Cost Standard Payments
(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.
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. 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.