Service and Performance Requirements
A Competent Harmony Healthcare Medicaid RUG and Medicaid Case Mix Professional (CHHI-RUG) is an interdisciplinary team member who successfully completes this 3 Day intensive, clinically founded training, geared towards providing and documenting outstanding patient care while understanding regulatory requirements and reimbursement related to Medicaid RUG and Medicaid Case Mix in a Skilled Nursing Facility (SNF) setting. This program is interactive with a focus on practical application for the clinical staff and interdisciplinary team.
This 8 hour course will provide a general overview of all 50 states and delineate which states utilize an MDS RUG Based Medicaid Reimbursement System, identify the basic method of reimbursement, as well as whether the state incorporates Value-Based Purchasing Quality Incentive Measures into the model. The session will focus on the below listed states:
- Alabama (not a CMI state)
- Alaska (not a CMI state)
- Arizona (not a CMI state)
- Arkansas (not a CMI state)
- California RUG-III 34 and Add-On
- Colorado RUG-III 34
- Connecticut RUG-IV 48 CMI and Add-On
- Delaware (not a CMI state)
- District of Columbia RUG-IV 48 (refresher) and Add-On
- Florida Add-On (not a CMI State)
- Georgia RUG-III 34
- Hawaii RUG-III 34
- Idaho RUG-IV 48
- Illinois RUG-IV 48
- Indiana RUG-IV 48
- Iowa RUG-III 34
- Kansas RUG-III 34Texas RUG-III 34, QUIPP-4 measures, Add-On: (QAPI, RN, IP, QM)
- Kentucky RUG-III 34 and Add-On
- Louisiana RUG-III 34
- Maine RUG-III 44
- Maryland RUG-IV 48
- Massachusetts Add-On MMQ (not a CMI State)
- Michigan (not a CMI State)
- Minnesota RUG-IV 48
- Missouri Add-On (not a CMI state)
- Montana RUG-III 34
- Nebraska RUG-III 34
- Nevada RUG-III 34
- New Hampshire RUG-IV 48
- New Jersey (not a CMI state)
- New Mexico (not a CMI state)
- North Carolina RUG-III 34 and Add-On
- North Dakota RUG-III 34
- Ohio RUG-IV 57, Ventilator and Pneumonia and Add-On
- Oklahoma (not a CMI state)
- Oregon (not a CMI state)
- Pennsylvania RUG-III 44
- Puerto Rico (not a CMI state)
- Rhode Island RUG-IV 48
- South Carolina Add-On (not a CMI state)
- South Dakota RUG-III 34
- Tennessee RUG-IV 48, QuiLTS and Add-On
- Texas RUG-III 34
- Utah RUG-III 34
- Vermont RUG-IV 48
- Virginia RUG-IV 48 (refresher) and Add-On
- Washington RUG-IV 57
- West Virginia RUG-III 34
- Wisconsin RUG-IV 48
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Wyoming (not a CMI state)
The HHI Medicaid RUG and Medicaid Case Mix 1 day course offers participants a comprehensive understanding of Medicaid Reimbursement in the context of:
Overview Medicaid RUG: Day 1
RUG Levels/Strategies and Documentation Medicaid RUG: Day 1
Recommended Audience
CEOs, COOs, Administrators, MDS Coordinators, Nurse Managers, Rehabilitation Managers, Nurses, Occupational Therapists, Physical Therapists, Speech Language Pathologists, Business Office Managers, Admissions Directors, and Social Services.
Goals
This program will enable healthcare providers to enhance quality of care through an improved understanding of the state specific Medicaid and Value-Based Purchasing reimbursement system.
Learning Outcomes
- Learner to identify whether the state Medicaid reimbursement system is Case Mix, MDS Based.
- Learner to identify whether the state Medicaid reimbursement system is based on Quality Incentive Program.
- Learner to identify the state-specific, Medicaid Case Mix and Quality Incentive reimbursementnuances.
Day 1 Agenda
8:30 a.m. to 11:45 a.m.
8:30 a.m. – 10:30 a.m.
- Overview/Case Mix and Quality Incentives
- RUG-III 34
- California, Colorado, Georgia, Hawaii, Iowa, Kansas, Kentucky, Louisiana, Montana, Nebraska, Nevada, North Carolina, North Dakota, South Dakota, Texas, Utah, West Virginia
10:30 a.m. – 10:45 a.m.
Break
10:45 a.m. – 11:45 a.m.
- RUG-III 44
- Maine, Pennsylvania
11:45 a.m. – 12:15 p.m.
Break
Day 1 Agenda
12:15 p. m. to 5:45 p.m.
12:15 p.m. – 2:15 p.m.
- RUG-IV 48
- Connecticut, District of Columbia, Idaho, Illinois, Indiana, Maryland, Minnesota, New Hampshire, Rhode Island, Tennessee, Vermont, Virginia, Wisconsin
- RUG-IV-57
- Ohio, Washington
2:15 p.m. – 2:30 p.m.
Break
2:30 p.m. – 4:30 p.m.
- Non-CMI States
- Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Michigan, Missouri, New Jersey, New Mexico, Oklahoma, Oregon, Puerto Rico, South Carolina, Wyoming
- MMQ
- Massachusetts
4:30 p.m. – 4:45 p.m.
Break
4:45 p.m. – 5:45 p.m.
- Strategies and Documentation
Contact Hours
NAB: 8ANCC: 8