The Pennsylvania Case-Mix Payment System uses the following CMI calculations:
- (1) An individual resident’s CMI shall be assigned to the resident according to the PDPM nursing component classification system.
- (2) The facility MA CMI shall be the arithmetic mean of the individual CMIs for MA residents identified on the nursing facility’s CMI report for the picture date. The facility MA CMI shall be used for rate determination under § 1187.96(a)(5) (relating to price-setting and rate-setting computations.) If there are no MA residents identified on the CMI report for a picture date, the Statewide average MA CMI shall be substituted for rate determination under § 1187.96(a)(5).
- (3) The total facility CMI is the arithmetic mean of the individual resident CMIs for all residents, regardless of payor, identified on the nursing facility’s CMI report for the picture date. The total facility CMI for the February 1 picture date shall be used for price and rate setting computations as specified in § 1187.96(a)(1)(i).
- (4) Picture dates that are used for rate setting beginning April 1, 2026, and thereafter will be calculated based on the PDPM CMIs in Appendix D (relating to patient driven payment model for case-mix adjusted nursing categories in the nursing facility reimbursement system).
Authority
The provisions of this § 1187.93 amended under sections 201(2), 206(2), 403(b) and 443.1(5) and (7) of the Human Services Code (62 P.S. § § 201(2), 206(2), 403(b) and 443.1(5) and (7)).
Source
The provisions of this § 1187.93 amended June 23, 2006, effective July 1, 2006, 36 Pa.B. 3207; amended August 26, 2011, effective retroactive to July 1, 2010, 41 Pa.B. 4630; amended August 1, 2025, effective August 2, 2025, 55 Pa.B. 5119. Immediately preceding text appears at serial pages (381342) to (381343).
Cross References
This section cited in 55 Pa. Code § 1187.96 (relating to price-setting and rate-setting computations).