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Rhode Island Price-Based System Update

August 22, 2013


Monica A. Motta, CPA

We are conducting an informal survey regarding the results of June, the first month of the price-based system. To date, the survey consists of 31% of the Rhode Island nursing facilities representing approximately 49,000 Medicaid paid days.

The comparative results below are based upon  the Medicaid average case mix index (CMI) for each facility for the period October 1, 2012 through May 31, 2013 compared to the Medicaid average CMI for the first month of implementation of the 48 RUG grouper payment.

Our survey group started with payments based upon an average Medicaid CMI from October 2012 through May 31, 2013 of .9915. The same group sustained a June 2013 average Medicaid CMI based upon paid days of .9801 or a 1.2% decrease in acuity. This equates to a reduction in Medicaid payments to these providers of approximately $60,000 or $1.20 per day for the month of June. Based upon an approximate 1.9 million Medicaid days for a one-year period, the state would sustain an estimated savings of $2.3 million from payments to nursing homes.

The results to date contain a proportionate share of for-profit and non-profit facilities. The results to date indicate 46% of the facilities sustained a decrease in their Medicaid average CMI with 54% sustaining an increase. The Medicaid rate changes for June from the previous paid amount ranged from a decrease of $12.03 per day to an increase of $13.73 per day.

We will continue to monitor the payment system as it unfolds and provide updates in our ever-changing landscape of the Medicaid payment system.  If you have any questions or would like to discuss further, please give us a call at 401-272-5600.


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