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What is “Perpetual” Case Mixing?

This blog was written and produced by Karen Donovan, Director of Clinical Operations at Beacon Solutions. Looking to get in touch with Karen? Reach out today: kdonovan@BeaconSolutionsGroup.com.

On Tuesday, May 11, 2021, the NYS DOH announced their intent to move away from the “frozen” or, “picture date” methodology and move forward with a “Perpetual Case Mix” Methodology. The concept takes away the “on/off” cyclical setting of rates based on two distinct and predictable 92-day windows, and instead uses all assessments during a six-month period to calculate case mix index (CMI) for rate setting purposes. While we believe there is still a ton to be settled before this is truly official, per DOH, the 7-2020 traditional snapshot is currently slated to be the last.

To manage “perpetual CMI” effectively, from a methodology standpoint, means keeping the CMI as high as possible at any given time. Obviously, to do that, it typically means a heightened awareness of subtle changes in every Medicaid resident’s individual acuity and then identifying and executing the MDS’s needed to support. For these same reasons, many feel this methodology makes it more difficult to accentuate the level of acuity associated with SNF care.

Because staff is already spread thin and every moment of the day seems accounted for, this is where you must be creative to economize the staff’s time and make every MDS count. Provider’s need to formalize their process to review and document each resident’s baseline. Subsequently, they should meet regularly to review status and strategize MDS’s if they will promote higher acuity. At the same time, we always encourage providers to take advantage of the reimbursement value associated with therapeutic services. Therapy can be a huge win/win where it comes to CMI acuity AND in maintaining optimal care services for the residents.

Part B therapy is often underutilized as many find it difficult to support with the lack of documentation and proper process to refer. Training your team to its value and giving them the tools to document well is the first step to promoting those programs.

So, where “perpetual” case mixing means you will be expected to manage this aspect of reimbursement every day, realize, with a few program adjustments and through enlightening your team to understand it, you will find it can be mastered.

At Beacon Solutions, we realize exactly how much effort and hard work goes into caring for an SNF population. As advocates of the work you do and experts in the fields of both Medicaid reimbursement strategy and outpatient Part B therapy, we can offer many helpful suggestions for managing this process successfully.

Beacon Solutions' clinical team has a variety of resources that are knowledgeable on NYS SNF Operations. If you need assistance, contact us today.

This material has been prepared for general, informational purposes only and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. Should you require any such advice, please contact us directly. The information contained herein does not create, and your review or use of the information does not constitute, an accountant-client relationship.