Nursing facility rates are determined by a cost report, which is based on a case mix of current residents in the facility. New cost reports are due annually from nursing facilities to determine the per diem, or daily rate, that is assigned by the Iowa Medicaid Provider Cost Audit and Rate Setting Unit.
The nursing facility rate reports are broken down into quarterly sections. The reports include:
- Cumulative Rate Listing: Medicaid rates by nursing facility beginning July 1, 2014, through the current rate quarter.
- Final Rate Summary: Nursing facility rate file listing for each nursing facility for the current rate quarter.
- Case Mix Index: Case mix index used for current rates.
- Cumulative Case Mix: Case mix index from quarter beginning January 1, 2004, through current.
- RUG Distribution Comparison: Comparison of statewide distribution of nursing facility residents between the 34-resource utilization groups (RUGs) for the current and previous quarter.
Hospice providers can use the Final Rate Summary report as a tool to determine the per diem rate based on the location of the nursing facility. There are instances when the rate listed for a particular nursing home may pay a different, lesser rate. Please contact the nursing home directly to confirm rates.
Access additional case mix roster and training information:
- PDPM Day Weighted Methodology for Case Mix Classification
- PDF: Day Weighted Case Mix Roster
- RUG III Calculations
- Training: Case Mix Rosters in IMPA
- Important Case Mix Dates:
- Case Mix Request Access for the IMPA System, Form 470-5642
- Case Mix Payer Change Form
- (NEW!) QAAF Training Materials
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