(1) TennCare or its
contractor shall provide each NF provider with the Preliminary Case Mix Index
Report (PCIR) by approximately the fifteenth (15th)
day of the second (2nd) month following the end of
the MDS assessment collection period for each semi-annual rate period. The PCIR
will serve as notice of the MDS assessments transmitted and provide an
opportunity for the NF provider to correct and transmit any missing MDS
assessments or tracking records or apply the CMS correction policy where
(2) As part of the PCIR
process, providers are required by TennCare to verify the end of therapy dates
associated with their submitted MDS assessments. TennCare will designate the
format and process providers must follow in order to satisfy the end of therapy
dates reconciliation process. Should a provider choose not to perform the
reconciliation of therapy dates, records with no discernable end of therapy
date will be given a default date of two days after the start of therapy date
associated with the record.
TennCare or its contractor shall provide each NF provider with a Final Case Mix
Index Report (FCIR) utilizing MDS assessments after allowing the NF provider
two (2) weeks, or ten (10) business days, to process its corrections. TennCare
may extend this time period if a request is received from the provider.
(a) A cut-off date will be published for each
case mix index report period. New or revised MDS assessment records or end of
therapy date updates submitted by the NF provider after the cut-off date will
not be included in the case mix index FCIR. TennCare, at its sole discretion,
may override the cut-off date if there are extraordinary circumstances
affecting a provider's ability to submit information.
(b) If TennCare determines that a NF provider
has delinquent MDS resident assessments, for purposes of determining both
average CMIs, such assessments shall be assigned the case mix index associated
with the RUG-IV group "BC1-Delinquent" or its successor. A delinquent MDS shall
be assigned a CMI value equal to the lowest CMI in the RUG-IV, or its
successor, classification system.
(4) The case mix index values from the FCIR
will be utilized in establishing NF provider reimbursement as described in Rule
Tenn. Comp. R. &
rule filed June 2, 1988; effective July 17, 1988. Repeal filed June 22, 1989;
effective August 4, 1989. Amendment filed March 18, 1994; effective June 1,
1994. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1,
2018; effective 7/30/2018.
Authority: T.C.A. §§
and Public Chapter 358 of the Acts of 1993.