Indiana Medicaid Models Fiscal Impact of Transition To RUGs IV

 IHCA met with representatives of the Division of Aging, Indiana Medicaid, and Myers & Stauffer on April 28th to review the State’s latest RUGs IV proposal.  They distributed two documents, one that shows the fiscal impact of moving to either the RUGs IV 48 or 66 grouper, and a second that compares CMIs between the two groupers according to rehab and non-rehab groups (click here for both documents).  No decision has been made as to which grouper they will choose, but IHCA suspects it will be the 66 grouper since that grouper saves the State money (i.e. reduces Medicaid rates for many facilities).  An announcement is being delayed until late-May as the State is also preparing fiscal impact on potential reduction to the occupancy penalty that would increase Medicaid rates for most facilities.

In addition, the State continues to contemplate the efficacy of the Special Care Unit Add-on as they argue that data from a Medicare-only study in 2009 indicates that such add-ons do not increase staffing.  IHCA has presented data to the State indicating that Special Care Units in-fact do have higher staffing.  The discussion about eliminating the Special Care Unit add-on began when the State first proposed a RUGs IV transition and at that time the State thought it would cost the State money and they were looking for an offset for that increased cost.

IHCA is not agreeable to any of the above changes, at least as they are currently proposed, and we are working with our Payment Committee and meeting with State officials and legislators to protect our profession and the residents we serve.