DHS Releases RFP for Consultant to Advise on Case Mix Transition

Posted on October 27, 2022 by Jeff Bostic

Earlier this week, the Minnesota Department of Human Services (DHS) released a Request for Proposal (RFP) hire a consultant who will review the RUGS-IV case mix system used in the state's Value-Based Reimbursement (VBR) care center payment system under Medicaid.

The state intends to have a consultant in place by the end of the year and recommendations by the middle of next year, with the transition likely to occur on Oct. 1, 2023.

Why Does DHS Need a New RUGS-IV System?

When the federal government switched to the Patient-Driven Payment Model (PDPM) for Medicare payment, it indicated it would stop providing RUG-IV scores. It plans to eliminate some information needed to calculate those scores from the Minimum Data Set Assessments (MDS). With those changes expected to happen on Oct. 1, 2023, the state will need an alternative case mix approach. Many states use RUGS-IV for Medicaid case mix and are also looking at making a transition.

About the RFP

The RFP asks the selected consultant to look at what other states are doing as a transition, to analyze the impact of transitioning VBR to using PDPM case mix, and to make recommendations on whether to transition to PDPM or an alternative and what steps are needed to complete a transition.

What's Next

LeadingAge Minnesota will advise DHS on the responses to the RFP and participate in stakeholder work led by the consulting firm chosen through the RFP process.