Recently Posted Preliminary Case Mix Index Reports 

Myers and Stauffer recently posted two versions of the “Preliminary Time-Weighted Case Mix Index Report for the Quarter 07/01/2025-09/30/2025” for each Medicaid participating nursing facility.   

One version is the usual format reflecting the preliminary case-mix information based on the RUG system. The other version shows what the preliminary case-mix would have been under the upcoming PDPM-based methodology. The PDPM version is for comparison and education purposes only.   

The RUG-based case-mix for the quarter ending 09/30/2025 will be used for the rates effective 01/01/2025. As part of the transition to PDPM case-mix, the rates effective for the quarters beginning 04/01/2025 and 07/01/2025 will be calculated using a frozen case-mix. The quarter(s) used for the frozen case-mix have not been determined yet. 

The case-mix values calculated with the PDPM methodology tend to be higher than those calculated under the traditional RUG methodology. The transition to PDPM case-mix is required to be budget neutral. The PDPM case-mix for each provider will need to be reduced to the point where the average PDPM case-mix is equal to the average expected RUG case-mix. This “budget neutralizing factor” is not included in the recently posted report. Comparing the calculated average CMIs between the RUG and PDPM reports is not an “apples-to-apples” comparison.