State-Specific PDPM Variations
This document describes state-specific variations to the standard PDPM calculation that are implemented in Clinware Admissions.
Overview
While PDPM is a federal Medicare payment system, some states have implemented variations or additional requirements that affect how PDPM is calculated for facilities within their jurisdiction. Clinware Admissions automatically applies these state-specific rules when calculating PDPM rates.
Nebraska (NE) - Long-Stay Nursing Component CMI
Source Document
This section is based on the official Nebraska PDPM documentation. View the source document →
Applicability
- State: Nebraska (NE)
- Facility Requirement: Facility must have Nebraska as their state
- Stay Duration: Applies to patients with stays over 100 days (days 101 through infinity)
- Component Affected: Nursing Component CMI only
- Product: Clinware Admissions
Calculation Rule
For Nebraska facilities, when a patient's stay exceeds 100 days, the standard PDPM calculation is modified for days 101 and beyond. During this period, only the Nursing Component uses the Nebraska-specific CMI values shown in the table below. All other PDPM components (PT, OT, SLP, NTA) continue to use the standard federal PDPM calculation.
Standard PDPM vs. Nebraska Long-Stay
| Period | Calculation Method |
|---|---|
| Days 1-100 | Standard PDPM calculation (all components) |
| Days 101+ | Standard PDPM for PT, OT, SLP, NTA components Nebraska-specific CMI for Nursing Component only |
Nebraska Nursing Component CMI Values
The following table shows the Case-Mix Index (CMI) values used for the Nursing Component in Nebraska facilities for stays over 100 days:
| PDPM Group Code | CMG Description | CMI Value |
|---|---|---|
| Extensive Services | ||
| ES3 | Tracheostomy and Ventilator | 4.06 |
| ES2 | Tracheostomy or Ventilator | 3.07 |
| ES1 | Infection Isolation | 2.93 |
| Special Care High | ||
| HDE2 | Depressed, Function Score 0-5 | 2.40 |
| HDE1 | Not Depressed, Function Score 0-5 | 1.99 |
| HBC2 | Depressed, Function Score 6-14 | 2.24 |
| HBC1 | Not Depressed, Function Score 6-14 | 1.86 |
| Special Care Low | ||
| LDE2 | Depressed, Function Score 0-5 | 2.08 |
| LDE1 | Not Depressed, Function Score 0-5 | 1.73 |
| LBC2 | Depressed, Function Score 6-14 | 1.72 |
| LBC1 | Not Depressed, Function Score 6-14 | 1.43 |
| Clinically Complex | ||
| CDE2 | Depressed, Function Score 0-5 | 1.87 |
| CDE1 | Not Depressed, Function Score 0-5 | 1.62 |
| CBC2 | Depressed, Function Score 6-14 | 1.55 |
| CBC1 | Not Depressed, Function Score 6-14 | 1.34 |
| CA2 | Depressed, Function Score 15-16 | 1.09 |
| CA1 | Not Depressed, Function Score 15-16 | 0.94 |
| Behavioral Symptoms & Cognitive Performance | ||
| BAB2 | Restorative Nursing ≥ 2 | 1.04 |
| BAB1 | Restorative Nursing = 1 or 2 | 0.99 |
| Reduced Physical Function | ||
| PDE2 | Restorative Nursing ≥ 2, Function Score 0-5 | 1.57 |
| PDE1 | Restorative Nursing = 1 or 2, Function Score 0-5 | 1.47 |
| PBC2 | Restorative Nursing ≥ 2, Function Score 6-14 | 1.22 |
| PBC1 | Restorative Nursing = 1 or 2, Function Score 6-14 | 1.13 |
| PA2 | Restorative Nursing ≥ 2, Function Score 15-16 | 0.71 |
| PA1 | Restorative Nursing = 1 or 2, Function Score 15-16 | 0.66 |
Classification Factors
The Nebraska Nursing Component CMI classification uses the same factors as standard PDPM:
- Clinical Complexity - Determines the base category (Extensive Services, Special Care, Clinically Complex, etc.)
- Depression Diagnosis - Affects CMI within each category (indicated by "2" suffix for depressed, "1" for not depressed)
- Functional Score - Section GG functional assessment scores (0-5, 6-14, 15-16, 24+)
- Restorative Nursing - Number of restorative nursing services provided
Example Calculation
Scenario: Nebraska facility, patient on day 105 of stay
- Days 1-100: Standard PDPM calculation applies to all components
- Days 101-105:
- PT, OT, SLP, NTA components: Continue using standard PDPM rates
- Nursing Component: Uses Nebraska-specific CMI based on patient classification
Implementation Notes
- Clinware Admissions automatically detects Nebraska facilities and applies this rule
- The system tracks stay duration and switches to Nebraska-specific calculation at day 101
- Only the Nursing Component CMI changes; all other components remain standard
- This rule applies for the remainder of the stay (days 101 through infinity)
For standard PDPM calculation details, see PDPM Overview