Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 207 - Institutional Long Term Care
Chapter 2 - Nursing Facility
Rule 23-207-2.10 - Case Mix Reimbursement and Case Mix Review

Universal Citation: MS Code of Rules 23-207-2.10

Current through September 24, 2024

A. The Division of Medicaid utilizes a resource utilization grouper-version 4 (RUG-IV) fortyeight (48) group model for case mix calculation for reimbursement.

1. Each of the forty-eight (48) resident classifications as well as the default classification is assigned case mix weights.

2. The classifications are calculated electronically using the minimum data set (MDS) assessment data and the RUG-IV calculation program.

B. Clinical documentation must be maintained in the clinical record which supports the MDS 3.0 assessment and substantiates the resources and services needed to provide care to the resident.

1. Review results are based only on the supporting original clinical documentation available and presented during the review.

2. No additional original clinical documentation will be accepted after the exit conference.

C. Documentation for case mix reimbursement must adhere to the Division of Medicaid's Supportive Documentation Requirements.

D. In addition to the clinical documentation review, the case mix review process includes a review of the facilities' official bed hold record which includes therapeutic and hospital leave records.

42 C.F.R. § 483.75; Miss. Code Ann. §§ 43-13-117, 43-13-121; SPA 15-004.

Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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