Casemix is by definition a system that classifies people into groups that are homogeneous in their use of resources. A casemix system also provides clinical descriptions of these individuals. The casemix system currently used in nursing facilities is the Resource Utilization Groups (RUG-III). The algorithm for RUG-III was developed to provide a patient-specific means of allocating health care resources based on the variable costs of caring for individuals with different needs.
The MDS is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid-certified nursing facilities. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing facility staff identify health problems. MDS assessments are required for residents on admission to the nursing facility and then periodically, within specific guidelines and time frames. MDS information is transmitted electronically by nursing facilities to the national MDS database at the Centers for Medicare and Medicaid Services (CMS) which is then sent to the MDS database in their respective states.
When a nursing facility resident moves in or out of a Medicaid-certified bed, the department must be notified using the Medicaid Bed Move Notice (see below). At a minimum, facilities that are not fully Medicaid certified (all beds) must complete and submit the notification spreadsheet once a month (preferably after reviewing the monthly care level report) or as applicable room moves occur. Bed moves to alike certified beds (from one Medicaid-certified bed to another or vice-versa) do not need to be reported.
To submit the form, please complete it and send to Tonya Remaklus, Administrative Specialist, at DHHS.NECaseMix@nebraska.gov or Tonya.Remaklus@Nebraska.gov.
For more information, see Casemix Web Access.
Effective October 1, 2010, CMS requires that nursing facilities use the 3.0 version of the MDS for resident assessments.
Federal revisions to Section Q of MDS 3.0 require that nursing facilities ask residents if they are interested in returning to the community and if they would like to speak to someone about this possibility. Nebraska Medicaid has designated the Nebraska Aging and Disability Resource Center as the section Q contact for nursing facility referrals.
Nebraska Medicaid uses the RUG-III 5.20 34-grouper version in calculating nursing facility reimbursement.