Nursing Facilities
Medicaid nursing facility services are a cornerstone of long-term services and supports, requiring sophisticated reimbursement methodologies, accurate clinical data, and strong financial oversight to ensure quality care and responsible stewardship of public funds. Myers & Stauffer partners with state Medicaid agencies to support nursing facility rate setting, case mix reimbursement, minimum data set validation, PDPM and RUG-IV methodologies, cost reporting, upper payment limit programs, and program integrity, helping states maintain compliance with Centers for Medicare & Medicaid Services requirements while strengthening payment accuracy and long-term program sustainability. Our integrated financial, clinical, and analytical expertise enables agencies to improve reimbursement, enhance oversight, and support high-performing Medicaid nursing facility programs.
Supporting Medicaid Nursing Facility Programs Through Reimbursement, Case Mix, & Program Oversight
Nursing facility services are a foundational component of Medicaid long-term services and supports (LTSS) programs. These programs involve complex reimbursement methodologies, detailed clinical data, and significant program expenditures, requiring specialized expertise to ensure accuracy, compliance, and sustainability.
States must balance appropriate provider reimbursement with program integrity, regulatory compliance, and access to quality care. This requires robust systems for rate setting, case mix measurement, and data validation.
We support state Medicaid agencies in managing and strengthening nursing facility programs through integrated reimbursement, clinical data, and oversight services. Our work reflects decades of experience and a deep understanding of how policy, payment, and operations intersect in long-term care.
Our Approach to Nursing Facility Programs
Nursing facility programs require close collaboration across reimbursement, clinical data, and program oversight. Our approach focuses on:
Where We Support Nursing Facilities
Nursing facility reimbursement is typically based on complex, cost-based methodologies that incorporate facility-specific cost data, case mix indices, and policy-driven adjustments. These systems often include resource utilization group (RUG)–based or patient-driven payment model (PDPM)–aligned methodologies, as well as value-based purchasing components tied to quality and performance.
We support agencies in developing, implementing, and maintaining rate-setting systems that are accurate, transparent, and aligned with program goals.
Our services include:
Our work helps ensure that reimbursement systems are both financially sound and operationally practical. Our experience spans legacy and evolving reimbursement models, including transitions from RUG-based systems to PDPM, as well as the integration of quality and value-based purchasing initiatives.
Case mix systems are central to nursing facility reimbursement, relying on accurate clinical data to reflect resident acuity and care needs. The minimum data set (MDS) is a key input to these systems and must be complete, accurate, and compliant with federal requirements. These data elements directly support RUG-IV and PDPM classification systems, making accuracy essential to both reimbursement and program integrity.
We bring specialized expertise in supporting case mix systems and validating MDS data.
Our services include:
Our work helps agencies ensure that reimbursement is based on reliable and supportable clinical data.
Nursing facility programs require strong oversight to ensure compliance with program requirements and appropriate use of Medicaid funds.
We support agencies in strengthening program integrity through:
Nursing facility programs generate large volumes of clinical and financial data. Effective use of this data is critical to program oversight, rate setting, and policy development.
We assist agencies with:
Integration with Medicaid LTSS Programs
Nursing facility services are a core component of broader LTSS systems, which also include home and community-based services (HCBS), intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IID) programs, and the Program of All-Inclusive Care for the Elderly (PACE).
We support agencies in:
Why Agencies Hire Myers & Stauffer
State Medicaid agencies nationwide rely on Myers & Stauffer for trusted expertise in nursing facility reimbursement, case mix systems, and program oversight. Our multidisciplinary team combines deep clinical, financial, and data analytics experience to deliver practical, objective solutions tailored to each state’s unique policies, reimbursement methodology, and long-term program goals.
Our nursing facility work is one of our longest-standing and most specialized service areas. We bring:
We understand the operational realities of nursing facility programs and tailor our approach to each state’s methodology, data systems, and policy priorities.
Our nursing facility services support:
We work with state Medicaid agencies to strengthen nursing facility programs through integrated reimbursement expertise, clinical data validation, and program oversight. Our focus is on delivering practical, sustainable solutions that support access to care while ensuring responsible stewardship of public funds.
Connect With Our Team
Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.
Dan Brendel
Principal
Email: dbrendel@mslc.com
Phone Number: 317-815-5492
Tara Clark, CPA
Member
Email: tclark@mslc.com
Phone Number: 888-749-5799
John Dresslar, CPA
Member
Email:jdresslar@mslc.com
Phone Number: 223-259-5306
In the Words of our Clients…
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