Issue Identified Affecting RUG Score Calculations for LTC Nursing Facilities

The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue affecting Resource Utilization Group (RUG) score calculations for long-term care (LTC) nursing facilities (NFs). This issue specifically impacts facilities that submitted Minimum Data Set (MDS) assessments for clients qualifying for multiple RUGs.

For MDS forms with an assessment reference date (ARD) on or after Oct. 1, 2023, the system selected the RUG with a lower case-mix index (CMI) score, resulting in a lower payment. Forms with an ARD prior to Oct. 1, 2023, were unaffected.

On Nov. 9, 2023, TMHP implemented a code fix to resolve this issue. Forms submitted on or after Nov. 10, 2023, will be processed with the correct RUG score calculations. For forms affected prior to the code fix, NFs can resubmit the forms, which will trigger the calculation to correct the RUG values, by taking the following steps:

1. Locate the affected MDS forms on the LTC Online Portal (LTCOP) by using the Form Status Inquiry (FSI) feature.
2. Open the form that was processed with an incorrect RUG value.
3. Click Correct this Form. A new (child) form will be created.
4. Add a note in the S10 Comments field in the LTCMI section (any note will do).
5. Click Submit to resubmit the MDS form. A new (child) document locator number (DLN) will be generated. 
   Note: Resubmitting the MDS form will initiate the medical necessity determination and HHS Service Authorization System (SAS) reprocessing.

For more information, call the LTC Help Desk at 800-626-4117 (select option 1).

This information is from the TMHP website.