Case Mix describes differences in residents within a population in terms of their physical and mental conditions and the resources that are used in their care. Case Mix reimbursement systems measure the intensity of care and services required for each resident and translate those measures into groupings. Those groupings are used in the calculation of facility payment.
Case Mix Weights
- Case Mix Weights for Washington State Grouper 57 effective 10/01/21
- Revised Prelim Q2 ’23 Excel |PDF
- Revised Prelim Q2 ’23 with HIPPS Excel |PDF
Documents
- Case Mix Accuracy Review (CMAR) Summary July 2020
- How to read a facility RUG Report
- Declaring Pending Medicaid Eligibility in the MDS
- MDS-WA Listserve Sign Up/Mange Subscriptions
- 2023 WA State RUG Report Run Schedule Word | PDF
- 2024 WA State RUG Report Run Schedule PDF
State Law and WA Admin Code
- RCW 74.46.485 - Case mix classification methodology.
- RCW 74.46.501 - Quarterly Average case mix indexes – Facility and Medicaid
- WAC 388-96 – NH Medicaid payment system
- WAC 388-96-738 - Default case mix group and weight when there is no MDS assessment
- WAC 388-96-905 - Case mix accuracy review of MDS nursing facility resident assessments
- WAC 388-96-904 - Administrative Review
- WAC 388-96-901 - Disputes
State of Washington Contacts
- Analyst, Technical Rates Section: Bobbie Howard 360-725-2474 bobbie.howard@dshs.wa.gov
- RAI Coordinator and Case Mix Accuracy Review Program Manager: Donna Zaglin 360-725-2487 donna.zaglin@dshs.wa.gov
- MDS Automation Coordinator: Betty Metz 360-725-3432 betty.metz@dshs.wa.gov
- MDSHelpdesk@dshs.wa.gov