Modifying the Case-Mix Medicaid Nursing Home System to Encourage Quality, Access and Efficiency

Posted on: 2010-10-01 00:00:06

With funding from the New York Community Trust, LTCCC undertook a study on case-mix reimbursement, the system of paying for nursing home care utilized by the majority of states, to identify and assess how each of these systems is structured and the impact of that structure on: quality of care, access to care for individuals with higher needs and the efficiency in the use of public funds. Project goals were to: (1) identify how states can modify their nursing home case-mix reimbursement systems to better encourage quality care, access and efficiency; (2) relate nursing home reimbursement to inspection and enforcement; (3) relate nursing home reimbursement to quality outcomes; and (4) respond to the specific budget proposals in our home state, New York State, as the it identifies, assesses and implements ways to modify its reimbursement system, so that it better achieves the goals of quality and efficiency in the face of the current economic crisis. In order to accomplish these goals, LTCCC: gathered detailed information on the characteristics of each of the 35 states using a case-mix nursing home Medicaid reimbursement system; surveyed state ombudsmen and representatives of citizen advocacy groups; selected seven states for in-depth analysis as case studies; and interviewed state officials from these seven states. All this information is detailed in the final report with specific recommendations for change.

Click on the buttons below to download free copies of the relevant documents.

Full Report - New York Edition

Full Report - National Edition

Executive Summary

Media Alert - March 2009

For earlier studies on case-mix click on the titles:

Case-Mix Reimbursement and RUGs: What Consumers Should Know

Modifying RUGs: Responding to Consumer Concerns in New York State,

and Case-Mix Reimbursement and the Nursing Home Resident in NYS.

LTCCC's Executive Director and Director of Special Projects Trains Advocates: How to Modify the Case-Mix Medicaid System in Their State

On October 23, 2009, Richard Mollot and Cynthia Rudder presented at the NCCNHR Annual Conference in Washington, DC. Their presentation consisted of an introduction to nursing home Medicaid reimbursement, why understanding reimbursement is crucial for advocates, findings and recommendations from the LTCCC study and ways in which advocates can make changes in their own state.

Click Here to Download Presentation

For information on Consumer Participation In Nursing Home Medicaid Reimbursement Policy Making go to http://www.ltccc.org/ConsumerParticipationinReimbursement.shtml

Share |
July 25, 2014
Subscribe to Nursing Home 411 via RSS What's New? 

Antipsychotic Drug Use in NY State Nursing Homes: An Assessment of New York’s Progress in the National Campaign to Reduce Drugs and Improve Dementia Care
Report: Antipsychotic Drug Use & Enforcement in NY State Nursing Homes Ex...

April 2014: CMS issues S&C Letter,
“Interim Report on the CMS National Partnership to Improve Dementia Care i...

The New York State Long Term Care Ombudsman Program: An Assessment of Current Performance, Issues & Obstacles
Report: Assessment of the NY State LTC Ombudsman Program Executive Summa...

Nursing Home Penalties Drop 33% in 2013 as New Federal Study Finds One in Three Harmed in Nursing Home Rehab
A Feb. 2014 report found that 33% of Medicare rehab patients suffer harm i...

LTCCC Dementia Care Symposium Report
February 2014 LTCCC releases a report on the results of a symposium for ca...


This Website is presented by the Long Term Care Community Coalition (LTCCC), a non-profit organization that works to improve long term care.

Site design
& data base solutions by
Kramerica Industries, LLC.

Long Term Care Community Coalition
One Penn Plaza, Suite 6252
New York, NY 10119
Tel: 212-385-0355