Tenn. Comp. R. & Regs. 1200-13-02-.08 - CASE MIX INDEX REPORTS PROCESS

(1) TennCare or its contractor shall provide each NF provider with the Preliminary Case Mix Index Report (PCIR) by approximately the fifteenth (15^th) day of the second (2^nd) 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 applicable.

(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.

(3) 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 .06.

Notes

Tenn. Comp. R. & Regs. 1200-13-02-.08

Original 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. §§ 4-5-202, 71-5-105, 71-5-109, 71-5-1413, and Public Chapter 358 of the Acts of 1993.