Begin Main Content Area

​Rates

On Jan. 1, 1996, the Department of Human Services implemented 55 PA.Code Chapter 1187, the Nursing Facilities Services Case-Mix Reimbursement System. Case mix rates for all Medical Assistance (MA) nursing facilities' were determined in accordance with the conditions and limitations specified in 55 PA.Code Chapter 1187 and the Commonwealth's Title XIX State Plan. Beginning, Fiscal Year 2006-07, the Department changed the rate setting methodology for MA county nursing facilities and reimbursed the facilities in accordance with 55 PA.Code Chapter 1189, for County Nursing Facilities, which was adopted June 23, 2006 and became effective July 1, 2006.

Long Term Care/Case Mix Rates

This section includes the most recent proposed case mix rates as well as final rates beginning January 1996. Click on the appropriate link below to initiate steps to view the rate information you are interested in. This information is updated as notification of the proposed and final rates is published in the Pennsylvania Bulletin.

Rate Files

The rate files are Excel spreadsheets and Microsoft Excel is needed to access these files. Some of these pages are large and contain a great deal of information - please be aware that they may require several minutes to load.

Proposed Rates - These are the most recent proposed case mix rates.

Condensed Final Rates - These are the condensed versions of final case mix rates. These documents consist of Provider Names, MA CMI Averages, and Final Rates.

Detailed Final Rates - These are the full Excel spreadsheets for final case mix rates. These spreadsheets consist of Provider Name, MA CMI Averages, Final Rates, Average Per Diems, Peer Group Prices, Limited Prices, Cost Center Rates, etc.

Crosswalk to Column Headings of Rate Spreadsheets

2018-2019 Detailed Final Rates

2017-2018 Detailed Final Rates

2016-2017 Detailed Final Rates

2015-2016 Detailed Final Rates

2014-2015 Detailed Final Rates

2013-2014 Detailed Final Rates

2012-2013 Detailed Final Rates

2011-2012 Detailed Final Rates

Criteria for Reversals 7/1/01

 

Proposed Rates:

 

Rate YearCounty Proposed Rates
2019- 2020View

 

Rate Month/YearNursing Facility Proposed Condensed RatesNursing Facility Proposed Detailed Rates
October 2019ViewView
July 2019     ViewView

 

 

 
                                                            County Final Rates:

Rate YearCounty Detailed Rates
2018-2019View 2018-2019 County Detailed Rates
2017-2018View 2017-2018 County Detailed Rates
2016-2017View 2016-2017 County Detailed Rates
2015-2016View 2015-2016 County Detailed Rates
2014-2015View 2014-2015 County Detailed Rates
2013-2014View 2013-2014 County Detailed Rates
2012-2013View 2012-2013 County Detailed Rates
2011-2012View 2011-2012 County Detailed Rates
2010-2011View 2010-2011 County Detailed Rates
2009-2010View 2009-2010 County Detailed Rates
2008-2009View 2008-2009 County Detailed Rates
2007-2008View 2007-2008 County Detailed Rates
2006-2007View 2006-2007 County Detailed Rates

 

Nursing Facility Final Rates:

Month/YearCondensed RatesDetailed RatesCrosswalk
April 2019View April, 2019 Condensed RatesView April, 2019 Detailed Rates 
January 2019View Jan, 2019 Condensed RatesView Jan, 2019 Detailed Rates 
October 2018View Oct. 2018 Condensed RatesView Oct. 2018 Detailed Rates 
July 2018View July 2018 Condensed RatesView July 2018 Detailed RatesView July 2018 Crosswalk
April 2018View April 2018 Condensed RatesView April 2018 Detailed Rates 
January 2018View Jan. 2018 Condensed RatesView Jan. 2018 Detailed Rates 
October 2017View Oct. 2017 Condensed RatesView 
July 2017View July 2017 Condensed RatesViewView 
April 2017View April 2017 Condensed RatesView 
January 2017View Jan. 2017 Condensed RatesView 
October 2016View Oct. 2016 Condensed RatesView 
July 2016 View July 2016 Condensed RatesViewView
April 2016View April 2016 Condensed RatesView 
January 2016View Jan. 2016 Condensed RatesView 
October 2015View Oct. 2015 Condensed RatesView 
July 2015 View July 2015 Condensed RatesView View 
April 2015View April 2015 Condensed RatesView 
January 2015View Jan. 2015 Condensed RatesView 
October 2014View Oct. 2014 Condensed RatesView 
July 2014 View July 2014 Condensed RatesView View
April 2014View April 2014 Condensed RatesView 
January 2014 View Jan. 2014 Condensed RatesView 
October 2013 View Oct. 2013 Condensed RatesView 
July 2013 View July 2013 Condensed RatesViewView 
April 2013 View April 2013 Condensed RatesView 
January 2013 View Jan. 2013 Condensed RatesView 
October 2012ViewView 
July 2012ViewView View 
April 2012ViewView 
January 2012ViewView 
October 2011ViewView 
July 2011ViewViewView 
April 2011ViewView 
January 2011ViewView 
October 2010ViewView 
July 2010ViewViewView
April 2010ViewView 
January 2010View View  
October 2009ViewView 
July 2009ViewViewView
April 2009ViewView 
January 2009ViewView 
October 2008ViewView 
July 2008ViewViewView
April 2008ViewView 
January 2008ViewView 
October 2007ViewView 
July 2007ViewViewView
April 2007ViewView 
January 2007ViewView 
October 2006ViewView 
July 2006ViewViewView
April 2006ViewView 
January 2006ViewView 
October 2005ViewView 
July 2005ViewViewView
April 2005ViewView 
January 2005ViewView 
October 2004ViewView 
July 2004ViewViewView
April 2004ViewView 
January 2004ViewView 
October 2003ViewView 
July 2003ViewViewView
April 2003ViewView 
January 2003ViewView 
October 2002ViewView 
July 2002ViewViewView
April 2002ViewView 
January 2002ViewView 
October 2001ViewView 
July 2001ViewViewView
April 2001ViewView 
January 2001ViewView 
October 2000ViewView 
July 2000ViewViewView
April 2000ViewView 
January 2000ViewView 
October 1999ViewView 
July 1999ViewViewView
April 1999ViewView 
January 1999ViewView 
October 1998ViewView 
July 1998ViewViewView
April 1998ViewView 
January 1998ViewView 
October 1997ViewView 
July 1997ViewViewView
April 1997ViewView 
January 1997ViewView 
October 1996ViewView 
July 1996ViewViewView
April 1996ViewView 
January 1996ViewView 

                                                                 Special Rehab Facility Final Rates:

Month/YearCondensed RatesDetailed Rates
April 2012ViewView
January 2012ViewView
November 2011ViewView

RUG (Resource Utilization Group) Information (10/08/2013)

This section includes RUG (Resource Utilization Group) information. Click on the appropriate link below to view the RUG information you are interested in.

RUG 5.12 44-grouper Crosswalk

Rapid RUG Guide for MDS 3.0 RUG-III, Version 5.12 44-grouper

5.12 44 Grouper (Starts February 1, 2010)

Total Facility CMI's in Pennsylvania

RUG III v. 5.12 44-Group CMI's in Pennsylvania (Selected Picture Dates)

Total - The Total Facility Case Mix Index (CMI) for each Pennsylvania MA nursing facility using RUG-III v. 5.12, 44-Group with Pennsylvania-normalized "nursing only" CMIs.

Selected February Picture Dates

RUG-III version 5.12 Group Normalized Nursing Only CMIs with Latest Assessment

Total Facility CMI's in Pennsylvania for February 2007, 2008 and 2009


Related Topics