Ready for the New CMI Rules?
The Medicaid landscape for skilled nursing facilities is changing rapidly. This year, there are two urgent Case Mix Index (CMI) updates you can’t afford to ignore:
1. Every State Plays By Different Rules
* Many states are blending PDPM with older RUGs approaches, customizing case mix weights, clinical groupings, and MDS coding requirements.
* Impact: Even small differences in coding or CMI calculation can mean hundreds in lost reimbursement per resident, each year.
2. Costlier Penalties For CMI Errors
* With these new systems, state Medicaid audits are increasing. Auditors are looking closely at MDS coding, functional scores, documentation, and more—and each state applies its own logic.
* The result? It’s easier than ever to make a costly error, and mistakes are penalized more aggressively. The margin for error is now razor-thin.
What Can You Do About It?
* Review the latest PDPM and MDS 3.0 updates from the Centers for Medicare & Medicaid Services (CMS): CMS MDS 3.0 Resident Assessment Instrument (RAI) Manual and Resources
* Bookmark your state’s Medicaid provider portal for up-to-date guidance on payment, CMI calculation, and audit protocols. You can find your state’s portal here: List of State Medicaid Agency Websites (Medicaid.gov)
