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Modifications to Medicaid Nursing Home Reimbursement
July 2006
The Update
According to a document received from the NYSHFA (New York State Health Facilities Association), the PRI System used for Patient Acuity Payment System will be converted to a RUG-III MDS based system. The conversion to an MDS and RUG-III based system will start January 1, 2007 and be completed by December 31, 2008. A working group will be convened by October 1, 2006 to address the conversion from the PRI System to a RUG-III and MDS based system. This group shall report their results during 2007 and 2008.
Facilities will not be required to complete PRI’s for reimbursement purposes on or after January 1, 2007. However, if a facility anticipates an increase in their case mix of greater than 0.05, then the facility must continue to complete full house PRI assessments through to December 31, 2008. By completing this PRI schedule, the facility would be able to qualify for an adjustment to their case mix.
The RUG-III calculator and method of calculation to be implemented have not been announced.
What Momentum is Doing
Momentum Healthware will review its current PRI functionality and confirm that functionality will be adequate to support those facilities that choose to complete and submit Full House assessments after January 1, 2007.
We will continue to monitor for future announcements by the Department of Health and document any change request required.
Last Updated: 07/17/2006
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The EHR system helps us provide better care to what’s often an increasingly complex clientele, for the same money. -Ray Koop, CEO
Luther Home, Winnipeg, Manitoba
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