The bill seeks to enhance the calculation of nursing rates for Medicaid services by amending existing laws to introduce new methodologies and definitions for case mix classifications and weights. It replaces the outdated resource utilization group IV case mix classification with a new approach based on data from the Centers for Medicare and Medicaid Services. Key amendments include the establishment of default case mix groups for residents who die or are discharged before their initial assessment and for cases with untimely assessments. The bill also revises definitions related to nursing facility operations, such as "rate" and "case mix weight," to align with the updated methodologies, ultimately aiming to improve the efficiency of Medicaid funding while maintaining care standards.

Additionally, the bill specifies that case mix weights will now be based on finalized weights published in the federal register and allows for more frequent revisions in response to significant variances in wage ratios among direct care staff. It outlines the process for determining average case mix indexes for each facility, including the inclusion of all residents during the applicable quarter and the exclusion of default cases. The legislation establishes a timeline for using resident assessment data to calculate these indexes and sets forth a semiannual update methodology for nursing facilities' direct care component rates based on the Medicaid average case mix index. Outdated provisions related to the transition to minimum data set 3.0 and resource utilization group IV are also removed.

Statutes affected:
Original Bill: 74.46.485, 74.46.496, 74.46.501