Nursing Home Casemix 2026

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The document is a final report evaluating the Nursing Home Casemix and Quality Demonstration funded by HCFA, which aimed to test a casemix-adjusted prospective payment system for Medicare and Medicaid in six states. The evaluation assesses the impact of this demonstration on various outcomes including nursing home admissions, staffing patterns, Medicare expenditures, and the provision of skilled therapy services. Key findings indicate that there were no significant systematic effects on nursing home behavior or quality of care, with mixed results regarding admissions and staffing levels. The report concludes that while the demonstration did not encourage adverse behaviors, its implications for a national program may differ significantly due to the mandatory nature of such a system.

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Click ‘Get Form’ to open the Nursing Home Casemix document in the editor.
Begin by filling out the resident's information in Section 1, including name, date of birth, and admission date. Ensure accuracy as this data is crucial for classification.
Proceed to Section 2, where you will assess the resident's functional status using the Minimum Data Set (MDS) criteria. This includes evaluating Activities of Daily Living (ADLs) such as bathing and dressing.
In Section 3, classify the resident according to their care needs using the Resource Utilization Groups (RUG-III) system. Select the appropriate category based on therapy requirements and complexity of care.
Review all entered information for completeness and accuracy before submitting. Utilize our platform’s features to save your progress or share with colleagues for collaborative input.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How is case mix determined for an inpatient facility?

Case mix groups are designed to aggregate acute care inpatients that are similar clinically and in terms of resource use. Acute care inpatients are assigned to groups based on clinical and administrative data collected via the Discharge Abstract Database (DAD).

How do you calculate the case mix?

The Case Mix Index (CMI) is the average relative DRG weight of a hospitals inpatient discharges, calculated by summing the Medicare Severity-Diagnosis Related Group (MS-DRG) weight for each discharge and dividing the total by the number of discharges.

What does case mix mean in nursing homes?

Case mix index is a metric that reflects the diversity, complexity, and severity of the patients treated at a healthcare facility, such as a hospital. Case mix index is used by the Centers for Medicare and Medicaid Services (CMS) to determine hospital reimbursement rates for Medicare and Medicaid beneficiaries.