Case Mix for Washington State Medicaid Nursing Home Payment

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

• 2nd Semi-Annual 2026 Preliminary Case Mix Report  Excel | PDF

Documents

• Declaring Pending Medicaid Eligibility in the MDS
• MDS-WA Listserve Sign Up/Manage Subscriptions
• 2026 WA State CMID Report Run Schedule PDF | Word
• 2027 WA State CMID Report Run Schedule PDF | Word

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