Section 1187.93. CMI calculations

The Pennsylvania Case-Mix Payment System uses the following CMI calculations:

(1) An individual resident’s CMI shall be assigned to the resident according to the RUG-III classification system.

(2) The facility MA CMI shall be the arithmetic mean of the individual CMIs for MA residents identified on the nursing facility’s CMI report for the picture date. The facility MA CMI shall be used for rate determination under § 1187.96(a)(5) (relating to price and rate-setting computations.) If there are no MA residents identified on the CMI report for a picture date, the Statewide average MA CMI shall be substituted for rate determination under § 1187.96(a)(5).

(3) The total facility CMI is the arithmetic mean of the individual resident CMIs for all residents, regardless of payor, identified on the nursing facility’s CMI report for the picture date. The total facility CMI for the February 1 picture date shall be used for price and rate setting computations as specified in § 1187.96(a)(1)(i).

(4) Picture dates that are used for rate setting beginning July 1, 2010, and thereafter will be calculated based on the RUG versions and CMIs set forth in Appendix A.

The provisions of this § 1187.93 amended June 23, 2006, effective July 1, 2006, 36 Pa.B. 3207; amended August 26, 2011, effective retroactive to July 1, 2010, 41 Pa.B. 4630. Immediately preceding text appears at serial pages (354214) to (354215).

Notation

Authority

The provisions of this § 1187.93 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P. S. § § 201(2), 206(2), 403(b) and 443.1(5).

Cross References

This section cited in 55 Pa. Code § 1187.96 (relating to price- and rate-setting computations).