In total, there are 11 variables and a constant used in the CDCS budget methodology for the Brain Injury (BI), Community Alternative Care (CAC) and Community Access for Disability Inclusion (CADI) waivers. However, each waiver does not use all 11 variables. All of the variables are data elements reported on or derived from the LTC Screening Document, DHS-3427 (PDF).

The following sections identify each variable/constant and the:

Formula

To view the formula, see CDCS – Budget methodology for the BI, CAC and CADI waivers.

Case mix is a classification that is used to establish payment levels and is based on the person’s:

The following resources will help to determine the person’s case mix:

Use the following information for the “case mix” variable.

Weight: 9.283

Range: A-K, which range from “low ADL need” (A) to “high ADL need, special nursing” (K). Case mix is not a linear variable. Use the following multipliers for each case mix level:

Field on DHS-3427: 50

Use the following information for the “walking” variable.

Weight: 2.663

Range: 0-4, which range from “walk without help of any kind” (0) to “cannot walk at all” (4).

Use the following information for the “grooming” variable.

Weight: 7.421

Range: 0-3, which range from “can comb your hair, wash your face, shave or brush your teeth without help of any kind” (0) to “is completely groomed by somebody else” (3)

Use the following information for the “bed mobility” variable.

Weight: 3.165

Range: 0-3, which range from “can move in bed without any help” (0) to “always needs and gets help to be turned and change positions” (3)

Use the following information for the “transfers” variable.

Weight: 3.008

Range: 0-4, which range from “can get in and out of a bed or chair without help of any kind” (0) to “never gets out of a bed or chair” (4)

The “behaviors 1” variable is only applicable to people on the BI-NF Waiver. It accounts for the significant behavioral needs of people who require a nursing facility level of care. Use the following information for this variable.

Weight: 22.462

Range: 0-4, which range from “behavior requires no intervention” (0) to “needs and receives behavior management and staff intervention because person is physically abusive to self and others; person may physically resist redirection” (4)

The “behaviors 2” variable is only applicable to people on the BI-NB Waiver. It accounts for the significant behavioral needs of people who require a neurobehavioral hospital level of care. Use the following information for this variable.

Weight: 77.495

Range: 0-4, which range from “behavior requires no intervention” (0) to “needs and receives behavior management and staff intervention because person is physically abusive to self and others; person may physically resist redirection” (4)

The “behaviors 3” and “behaviors 4” variables are only applicable to people on the CADI Waiver. Use only one, depending on if the person has a history of either a mental illness (MI) or brain injury (BI) diagnosis.

If history of MI or BI (behaviors 3)

If the person has a history of either an MI or a BI diagnosis (fields 19 or 20, respectively), and indicates behaviors (field 45), use the following information for the “behaviors 3” variable.

Weight: 22.462

Range: 0-4, which range from “behavior requires no intervention” (0) to “needs and receives behavior management and staff intervention because person is physically abusive to self and others; person may physically resist redirection” (4)

If no history of MI or BI (behaviors 4)

If the person does not have a history of either an MI or BI diagnosis (fields 19 or 20, respectively), but indicates behaviors (field 45), use the following information for the “behaviors 4” variable.

Weight: 5.494

Range: 0-4, which range from “behavior requires no intervention” (0) to “needs and receives behavior management and staff intervention because person is physically abusive to self and others; person may physically resist redirection” (4)

The “behaviors 5” variable is only applicable to people on the CAC Waiver. It accounts for the significant behavioral needs of people who require a hospital level of care. Use the following information for this variable.

Weight: 5.494

Range: 0-4, which range from “behavior requires no intervention” (0) to “needs and receives behavior management and staff intervention because person is physically abusive to self and others; person may physically resist redirection” (4)

The “CAC” variable is only applicable to people on the CAC Waiver. Use the following information for this variable.

Weight: 417.016

Range: 0 or 1, where:

The constant is 15.218. It is the base amount applied to every person.