CT Case Mix Rollout Plan Approved- First Phase Set to Begin Next Week

The Connecticut Department of Social Services (DSS) recently announced the Office of Policy Management (OPM) has approved a three-year plan for the implementation of a Medicaid Case Mix Index payment system in Connecticut. The outlined plan includes multiple phases, with full Case Mix implementation scheduled to occur in 2024.

Important Dates: CT Case Mix Rollout

9/29/21, 3:00pm Case Mix Phase-In Methodology Webinar

Representatives from Myers and Stauffer LLC will present a webinar on the Case Mix three-year phase-in plan, rate setting mechanics, phase-in mechanics and how shadow rates will be distributed to providers.

10/1/21-6/30/22 “Shadow” Case Mix System

During this period, facility specific rates will be calculated and shared based on the Case Mix Index. Rates will be updated on a quarterly basis. It is important to note, rates will not be implemented until full Case Mix implementation on 7/1/24.

7/1/22 – 6/30/23 Complete Stop Loss

This phase provides financial limitations as providers transition towards full implementation of a Case Mix Index system. If a facility is designated as gaining or losing above a certain threshold, DSS will stop the loss.

7/1/23 – 6/30/24 $5 Stop Loss

This phase offers similar constraints as the Complete Stop Loss phase. If a facility is designated as gaining or losing more than $5/day of their Medicaid rate, DSS will stop the loss.

7/1/24 – 6/30/25 Full Case Mix Implementation

Wondering how the CMI payer system will influence your reimbursement and clinical operations? Celtic supports our clients by identifying opportunities to optimize Case Mix system processes through analysis, targeted education and mentorship. Let’s discuss options to achieve your goals in the new system.

About Lauren Videtto