Long Term Care Case Mix Rates

On January 1, 1996, the Department of Public Welfare (Department) implemented 55 PA.Code Chapter 1187, the Nursing Facilities Services Case-Mix Reimbursement System. Case mix rates for all Medical Assistance (MA) nursing facilities’ were determined in accordance with the conditions and limitations specified in 55 PA.Code Chapter 1187 and the Commonwealth’s Title XIX State Plan. Beginning, Fiscal Year 2006-2007, the Department changed the rate setting methodology for MA county nursing facilities and reimbursed the facilities in accordance with 55 PA.Code Chapter 1189, for County Nursing Facilities, which was adopted June 23, 2006 and became effective July 1, 2006.

Long Term Care/Case Mix Rates

This section includes the most recent proposed case mix rates as well as final rates beginning January 1996. Click on the appropriate link below to initiate steps to view the rate information you are interested in. This information is updated as notification of the preposed and final rates is published in the Pennsylvania Bulletin.

Rate Files

The rate files are Excel spreadsheets and Microsoft Excel is needed to access these files. Some of these pages are large and contain a great deal of information - please be aware that they may require several minutes to load

Proposed Rates - These are the most recent proposed case mix rates.

Condensed Final Rates - These are the condensed versions of final case mix rates. These documents consist of Provider Names, MA CMI Averages, and Final Rates.

Detailed Final Rates - These are the full Excel spreadsheets for final case mix rates. These spreadsheets consist of Provider Name, MA CMI Averages, Final Rates, Average Per Diems, Peer Group Prices, Limited Prices, Cost Center Rates, etc.

Crosswalk to Column Headings of Rate Spreadsheets

Criteria for Reversals 7/1/01

Special Rehab Facility Proposed Rates: 

Month/Year	Condensed Rates	Detailed Rates
April 2012	View	View
January 2012	View	View
November 2011	View	View

County Proposed Rates:

Rate Year	County Detailed Rates
2012-2013	View

County Final Rates:

Rate Year	County Detailed Rates
2011-2012	View
2010-2011	View
2009-2010	View
2008-2009	View
2007-2008	View
2006-2007	View

Nonpublic Nursing Facility Proposed Rates:

Month/Year	Condensed Rates	Detailed Rates
April 2013	View	View
January 2013	View	View
October 2012	View	View
July 2012	View	View

Nursing Facility Final Rates: 

Month/Year	Condensed Rates	Detailed Rates	Crosswalk
April 2012	View	View	View
January 2012	View	View	View
October 2011	View	View	View
July 2011	View	View	View
April 2011	View	View	View
January 2011	View	View	View
October 2010	View	View	View
July 2010	View	View	View
April 2010	View	View	View
January 2010	View	View	View
October 2009	View	View	View
July 2009	View	View	View
April 2009	View	View	View
January 2009	View	View	View
October 2008	View	View	View
July 2008	View	View	View
April 2008	View	View	View
January 2008	View	View	View
October 2007	View	View	View
July 2007	View	View	View
April 2007	View	View	View
January 2007	View	View	View
October 2006	View	View	View
July 2006	View	View	View
April 2006	View	View	View
January 2006	View	View	View
October 2005	View	View	View
July 2005	View	View	View
April 2005	View	View	View
January 2005	View	View	View
October 2004	View	View	View
July 2004	View	View	View
April 2004	View	View	View
January 2004	View	View	View
October 2003	View	View	View
July 2003	View	View	View
April 2003	View	View	View
January 2003	View	View	View
October 2002	View	View	View
July 2002	View	View	View
April 2002	View	View	View
January 2002	View	View	View
October 2001	View	View	View
July 2001	View	View	View
April 2001	View	View	View
January 2001	View	View	View
October 2000	View	View	View
July 2000	View	View	View
April 2000	View	View	View
January 2000	View	View	View
October 1999	View	View	View
July 1999	View	View	View
April 1999	View	View	View
January 1999	View	View	View
October 1998	View	View	View
July 1998	View	View	View
April 1998	View	View	View
January 1998	View	View	View
October 1997	View	View	View
July 1997	View	View	View
April 1997	View	View	View
January 1997	View	View	View
October 1996	View	View	View
July 1996	View	View	View
April 1996	View	View	View
January 1996	View	View	View