CLEVELAND-ELYRIA, OH (CBSA 17460) CASE MIX ADJUSTED FEDERAL PATIENT ...

CLEVELAND-ELYRIA, OH (CBSA 17460) CASE MIX ADJUSTED FEDERAL PATIENT DRIVEN PAYMENT MODEL (PDPM) RATES

EFFECTIVE OCTOBER 1, 2020 THROUGH SEPTEMBER 30, 2021 CBSA WAGE INDEX: 0.8847

RATES SHOWN PRIOR TO QUALITY REPORTING AND VALUE-BASED PURCHASING ADJUSTMENTS

Clinical Category

Section GG PT Case Mix

Function Score

Group

Major Joint

0-5

TA

Replacement or

6-9 10-23

TB TC

Spinal Surgery

24

TD

0-5

TE

Other Orthopedic

6-9 10-23

TF TG

24

TH

0-5

TI

Medical Management

6-9 10-23

TJ TK

24

TL

Non-Orthopedic

0-5

TM

Surgery and Acute

6-9 10-23

TN TO

Neurologic

24

TP

Default

PT Case Mix Index

1.53 1.70 1.88 1.92 1.42 1.61 1.67 1.16 1.13 1.42 1.52 1.09 1.27 1.48 1.55 1.08

HIPPS Group

A B C D E F G H I J K L M N O P Z

PT Federal Rate

94.92 105.47 116.64 119.12 88.10 99.88 103.61 71.97 70.11 88.10 94.30 67.62 78.79 91.82 96.16 67.00 67.00

PT Wage Adjusted

Rate

87.12 96.80 107.05 109.33 80.86 91.67 95.09 66.05 64.35 80.86 86.55 62.06 72.31 84.27 88.25 61.49 61.49

Presence of Acute Neurologic Condition, SLP-Related

Comorbidity - OR - Cognitive Impairment

Presence of Mechanically Altered Diet - OR - Swallowing

Disorder

SLP Case Mix Group

SLP Case Mix Index

HIPPS Group

None

Neither Either

SA

0.68

A

SB

1.82

B

Both

SC

2.67

C

Neither

SD

1.46

D

Any one

Either

SE

2.34

E

Both

SF

2.98

F

Any two

Neither Either

SG

2.04

G

SH

2.86

H

Both

SI

3.53

I

All three

Neither Either

SJ

2.99

J

SK

3.70

K

Both

SL

4.21

L

Default

Z

SLP Federal Rate

15.75 42.15 61.84 33.81 54.19 69.02 47.25 66.24 81.75 69.25 85.69 97.50 15.75

SLP Wage Adjusted Rate

14.46 38.68 56.76 31.03 49.74 63.35 43.37 60.79 75.03 63.56 78.65 89.48 14.46

Clinical Category

Section GG Function Score

Major Joint Replacement or Spinal Surgery

Other Orthopedic

Medical Management

Non-Orthopedic Surgery and Acute

Neurologic

0-5 6-9 10-23 24 0-5 6-9 10-23 24 0-5 6-9 10-23 24 0-5 6-9 10-23 24 Default

OT Case Mix Group

TA TB TC TD TE TF TG TH TI TJ TK TL TM TN TO TP

OT Case Mix Index

1.49 1.63 1.69 1.53 1.41 1.60 1.64 1.15 1.18 1.45 1.54 1.11 1.30 1.50 1.55 1.09

HIPPS Group

A B C D E F G H I J K L M N O P Z

OT Federal Rate

86.05 94.13 97.60 88.36 81.43 92.40 94.71 66.41 68.15 83.74 88.94 64.10 75.08 86.63 89.51 62.95 62.95

OT Wage Adjusted

Rate 78.98

86.39 89.58 81.10

74.74 84.80 86.92 60.95

62.55 76.86 81.63 58.83

68.91 79.51 82.15 57.77 57.77

Non-Thearpy Ancillary Comorbidity Points

12+ 9-11 6-8 3-5 1-2

0 Default

NTA Case Mix Group NA NB NC ND NE NF

NTA Case Mix Index 3.24 2.53 1.84 1.33 0.96 0.72

HIPPS Group

A B C D E F Z

NTA Federal Rate

264.38 206.45 150.14 108.53 78.34 58.75 58.75

NTA Wage Adj. Rate

242.65 189.48 137.80 99.61 71.90 53.92 53.92

Non-Case-Mix Federal Rate 96.85

Non-Case-Mix Wage Adjusted

Rate 88.89

Nursing Category

Extensive Services

Conditions/Services

Trach AND Vent/Resp Care Trach OR Vent/Resp Care

Infection Isolation

Present?

Yes Yes Yes Yes

Section GG Function

Score 0-14

0-14 0-14 0-5

PDPM Nursing Case Nursing RUG Mix Index

ES3

4.06

ES2

3.07

ES1

2.93

HDE2

2.40

HIPPS Group

Nursing Federal Nursing Wage

Rate

Adjusted Rate

A

439.13

403.03

B

332.05

304.75

C

316.91

290.86

D

259.58

238.24

Special Care High

Depressed

No

0-5

HDE1

1.99

Yes

6-14

HBC2

2.24

No

6-14

HBC1

1.86

Yes

0-5

LDE2

2.08

E

215.24

197.55

F

242.28

222.36

G

201.18

184.64

H

224.97

206.48

Special Care Low

Depressed

No

0-5

LDE1

1.73

Yes

6-14

LBC2

1.72

No

6-14

LBC1

1.43

Yes

0-5

CDE2

1.87

I

187.12

171.74

J

186.04

170.75

K

154.67

141.95

L

202.26

185.63

No

0-5

CDE1

1.62

M

175.22

160.82

Clinically Complex

Depressed

Yes

6-14

CBC2

1.55

Yes

15-16

CA2

1.09

No

6-14

CBC1

1.34

No

15-16

CA1

0.94

Behavioral Cognitive Symptoms

Restorative Nursing Services 2 or More 0-1

11-16 11-16

BAB2 BAB1

1.04 0.99

2 or More

0-5

PDE2

1.57

N

167.65

153.87

O

117.89

108.20

P

144.93

133.02

Q

101.67

93.31

R

112.49

103.24

S

107.08

98.28

T

169.81

155.85

0-1

0-5

PDE1

1.47

Reduced Physical Function

Restorative Nursing Services

2 or More 2 or More

6-14 15-16

PBC2 PA2

1.22 0.71

0-1

6-14

PBC1

1.13

0-1

15-16

PA1

0.66

Default

U

159.00

145.93

V

131.96

121.11

W

76.79

70.48

X

122.22

112.17

Y

71.39

65.52

Z

71.39

65.52

Notes:

1. The per diem rate for a given resident will be the sum of federal rates for each category. This sum will be subject to the wage adjustment. For

presentation and analysis purposes, we have shown the wage adjustment applied to each category separately. Final rates paid may be slightly different

due to rounding.

2. Non-therapy ancillaries will be paid at 300% for the first three days of a resident's stay.

3. Physical and occupational therapies will be paid at 100% for the first 20 days of a resident's stay. From days 21 through 100, these rates will be reduced

by 2% for each additional seven days of a resident's stay.

4. Residents with a diagnosis of HIV/AIDS will receive an 18% add-on to the nursing component of the PDPM payment.

The Federal rates are based upon the final rule published in the August 5, 2020 federal register adjusted for the county CBSA wage adjustment. Rates subject to change if subsequent Correction Notice is issued.

Ohio CBSA #17460-Cleveland-Elyria (includes Cuyahoga, Geauga, Lake, Lorain, Medina counties)

Copyright ? 2020 HW&Co. All Rights Reserved.

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