Nursing Facility Rates
On Jan. 1, 1996, the Department of Human Services (DHS) 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, DHS 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.
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 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
County Final Rates
Nursing Facility Final Rates
Special Rehab Facility Final Rates
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.
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