Tenn. Comp. R. & Regs. 1200-13-02-.07 - CASE MIX INDEX CALCULATION

(1) The Resource Utilization Groups-IV (RUG-IV) Version 1.03, 48-Grouper, or its successor, index maximizer model shall be used as the resident classification system to determine all case mix indices, using data from the minimum data set (MDS) submitted by each NF provider. Standard Version 1.03, or its successor, case mix indices developed by CMS, using nursing-only RUG weights, shall be the basis for calculating average case mix indices to be used to adjust the direct care case mix adjusted cost component.
(2) Each resident in the facility with a completed and submitted assessment shall be assigned a RUG-IV 48-Grouper, or its successor. The RUG-IV 48 Grouper, or its successor, will be calculated using each resident MDS assessment transmitted and accepted by CMS. These assessments are then translated to the appropriate case mix index using the time-weighted acuity measurement system. Using the individual resident case mix indices, two NF provider case mix indices are calculated, the NF-wide semi-annual average case mix index and the Medicaid NF-wide semi-annual average case mix index. The two case mix indices for each Medicaid participating NF shall be determined two times per year.
(3) Any MDS assessments or MDS assessment periods which coincide with a federally or state declared public health emergency period may be excluded from or have BC1-Delinquent records removed from the calculation of the semi-annual case mix index averages. In the event that less than three (3) months of MDS assessment information is available for the semi-annual case mix index average calculations after exclusion, the most recently preceding semi-annual case mix index average calculations which contain three (3) or more months of MDS assessment information will be utilized for rate setting.


Tenn. Comp. R. & Regs. 1200-13-02-.07
(Formerly numbered as 1200-13-02-.06 ). Original rule filed June 25, 1985; effective July 25, 1985. Amendment filed June 2, 1988; effective July 17, 1988. Amendment filed January 30, 1989; effective March 16, 1989. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed January 28, 2021; effective 4/28/2021.

Authority: T.C.A. ยงยง 4-5-202, 14-23-105, 14-23-109, 14-23-130, 14-23-201, 71-5-105, 71-5-109, and 715-1413.

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