Nursing Facility Rate Setting and MDS Verification
Engagement Team

JD

“Through our work and vast experience we have become a national leader in case mix and MDS initiatives for nursing facility services.” Kris Knerr, CPA, member and Partner-in-Charge of the Nursing Facility Rate Setting and MDS Verification team

Who We Are

The firm has been involved since the earliest days of case mix rate setting for Medicaid nursing facility services. Our involvement with the CMS demonstration project in the early 1990s makes us a national resource with significant history in developing case mix systems. We have grown to consulting 15 states on a continuing basis to establish case mix rates for Medicaid nursing facility services.

Selected Clients
  1. Indiana Family and Social Services Administration
  2. Kentucky Cabinet for Health and Family Services

What We do

We provided consulting services to state agencies for an area that is often one of the most costly for the agency. The cost of nursing home care makes up a significant amount of each state agency’s Medicaid budget. In addition, nursing facility services involves a proportionately lower number of Medicaid beneficiaries, making it a highly-monitored and often scrutinized program, yet also politically sensitive because it deals with the most elderly and frail of the Medicaid population. These challenging dynamics make state agency decision-making difficult for this program. We offer creative solutions to a highly technical, analytically-complex set of issues. Our team includes skilled analysts, accountants, RN consultants and IT professionals who develop leading-edge concepts and reimbursement model design.

Current initiatives involve implementing quality-of-care concepts into the reimbursement system design, bringing about innovative changes to reimbursement system design that will be pivotal in the movement of health care reform as payors continue to expect cost containment, value and quality out of the services provided.

Where We're Headed

As health care initiatives continue to move in the direction of reform, we anticipate the nursing facility engagement team will be involved in leading edge projects that will likely be watched nationally by other state agencies. In particular, two upcoming reform initiatives relate to the inclusion of nursing facility services in a managed care arrangement and the idea of incorporating quality incentives into the reimbursement systems.