10A NCAC 22G .0105. CASE-MIX INDEX CALCULATION

(a)  The Resource Utilization Groups-III (RUG-III) Version 5.12b, 34 group, 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 facility to the Division of Health Service Regulation.  The following case-mix indices shall be the basis for calculating facility average case-mix indices to be used in determining the facility's direct care rate.

 

                                RUG       Case-Mix              RUG       Case-Mix              RUG       Case-Mix

                                Code      Index                     Code      Index                     Code      Index

                                SE3         2.08                        CB2        1.13                        PE2         0.97

                                SE2         1.70                        CB1        1.01                        PE1         0.96

                                SE1         1.45                        CA2        1.02                        PD2        0.91

                                RAD       1.68                        CA1        0.92                        PD1        0.83

                                RAC       1.41                        IB2         0.89                        PC2        0.82

                                RAB       1.28                        IB1         0.82                        PC1        0.80

                                RAA       1.06                        IA2         0.74                        PB2        0.66

                                SSC        1.40                        IA1         0.64                        PB1        0.61

                                SSB        1.29                        BB2        0.86                        PA2        0.60

                                SSA        1.25                        BB1        0.80                        PA1        0.57

                                CC2        1.39                        BA2        0.72

                                CC1        1.23                        BA1        0.61

 

(b)  Each resident in the facility on the last day of each quarter with a completed and submitted assessment shall be assigned a RUG-III 34 group calculated on the resident's most current assessment available on the last day of each calendar quarter.  This RUG-III group shall be translated to the appropriate case-mix index referenced in Paragraph (a) of this Rule.  If the most current assessment available on the last day of the calendar quarter is a delinquent MDS then the RUG-III code assigned shall be a BC1-delinquent and the lowest case-mix index in Paragraph (a) of this Rule shall be applied.  A delinquent MDS is defined as 121 days from the R2b date of the MDS assessment (completion date).  From the individual resident case-mix index, two average case-mix indices for each Medicaid nursing facility shall be determined four times per year based on the last day of each calendar quarter.

(c)  The facility-wide average case-mix index is the simple average, carried to four decimal places, of all resident case-mix indices.  The Medicaid average case-mix index is the simple average, carried to four decimal places, of all indices for residents where Medicaid or Medicaid pending is known to be the per diem payor source on the last day of the calendar quarter.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; S. L. 1985, c. 479, s. 86; 42 C.F.R. 447, Subpart C;

Eff. January 1, 1978;

Amended Eff. March 25, 1980;

Temporary Amendment Eff. October 1, 1984 for a Period of 120 Days to Expire on January 28, 1985;

Amended Eff. March 1, 1994; April 1, 1988; January 28, 1985;

Temporary Amendment Eff. August 3, 2004;

Amended Eff. January 1, 2005.