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

LTCCC'S new report, supported by a grant from the New York Community Trust, gives recommendations for all states using a case-mix methodology, as well as specifics for New York State, on ways to modify the system to focus more on quality outcomes rather than primarily on facility costs.  Project goals were to:  (1) modify the nursing home case-mix system to better encourage quality care, access and efficiency; (2) relate nursing home reimbursement to inspection and enforcement systems; (3) relate nursing home reimbursement to quality outcomes; and (4) respond to the specific New York State budget proposals as the state identifies, assesses and implements ways to modify its reimbursement system, so that it better achieves these 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 34 states using a case-mix nursing home Medicaid reimbursement system similar to New York; surveyed state ombudsmen and representatives of citizen advocacy groups; selected seven states for further 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.

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