D.C. Mun. Regs. tit. 29, r. 29-6505
Each nursing facility's allowable nursing and resident care Medicaid reimbursable costs shall be adjusted in accordance with § 6505.4.
The total resident days shall be determined in accordance with § 6515.2.
The amount calculated in § 6505.1 shall be divided by the Total Facility Case Mix Index to establish case mix neutral costs. This process is known as case mix neutralization. For the base year, total facility case mix will be the average facility-wide case mix for the three calendar quarters beginning January 1, 2015 and ending September 30, 2015.
For nursing and resident care costs other than the cost for speech therapy, occupational therapy, and physical therapy, the case mix neutral costs established in § 6505.3 shall be divided by the resident days calculated in accordance with § 6505.2 to determine each nursing facility's nursing and resident care cost per diem without physical, speech and occupational therapy services.
Per diem costs for physical, speech and occupational therapy services shall be calculated by dividing such costs by total Medicaid resident days. The resulting per diem shall be added to the per diem for nursing and resident care costs, excluding the costs for speech therapy, occupational therapy, and physical therapy. The resulting sum of the per diems shall comprise each nursing facility's nursing and resident care cost per diem unadjusted for case mix.
The peer group price established in accordance with § 6505.3 for nursing and resident care costs for each peer group shall be reduced for any facility whose nursing and resident care cost per diem adjusted for Medicaid case mix does not meet the established minimum percentage of the Medicaid case mix adjusted peer group price (the "floor").
The difference between the facility Medicaid case mix adjusted cost per diem and the floor is subtracted from the Medicaid case mix adjusted peer group price for that facility. Th e resulting value is divided by the facility Medicaid case mix to determine the facility specific nursing and resident care Medicaid case mix neutral per diem price. In the base year, the Medicaid case mix used in the calculations in §§ 6505.6 and 6505.7 is the average case mix for the quarters ending June 30, 2016 and September 30, 2016.
For rebasing periods after February 1, 2018, the nursing and resident care cost per diem shall be adjusted for Medicaid case mix using the day-weighted average Medicaid case mix of the preceding federal fiscal year for each facility, based on the Medicaid case mix of final paid claims for that facility for nursing facility services.
D.C. Mun. Regs. tit. 29, r. 29-6505