Tennessee Medicaid

Case-Mix In Tennessee

Tennessee has announced its intention of moving towards the 48 RUG grouper for Medicaid in skilled nursing facilities. This post is intended to be a reference about the 48 grouper you’ll be using in Tennessee.

You are in good company

The 48 grouper is used by quite a few states. Its use is also growing. You can see how many states are using the 48 grouper in green. (Gray states either aren’t case mix or I’m not familiar with it.)

You are using a standard weight set

RAE 1.65 Rehab
RAD 1.58
RAC 1.36
RAB 1.10
RAA 0.82
ES3 3.00 Ext Srvc
ES2 2.23
ES1 2.22
HE2 1.88 Special Care High
HE1 1.47
HD2 1.69
HD1 1.33
HC2 1.57
HC1 1.23
HB2 1.55
HB1 1.22
LE2 1.61 Special Care Low
LE1 1.26
LD2 1.54
LD1 1.21
LC2 1.30
LC1 1.02
LB2 1.21
LB1 0.95
CE2 1.39 Clinically Complex
CE1 1.25
CD2 1.29
CD1 1.15
CC2 1.08
CC1 0.96
CB2 0.95
CB1 0.85
CA2 0.73
CA1 0.65
BB2 0.81 Behavioral
BB1 0.75
BA2 0.58
BA1 0.53
PE2 1.25 Reduced Physical Function
PE1 1.17
PD2 1.15
PD1 1.06
PC2 0.91
PC1 0.85
PB2 0.7
PB1 0.65
PA2 0.49
PA1 0.45

“CMS Set F01” to be specific. That’s good news because so far that means every state that has switched to the 48 grouper has chosen the same weight set. That makes it much easier to find resources and compare performance across states. (It also makes it a lot easier for analysis.)

I’m showing the weights to the right. Note that they are more simple than many weight sets in use with other groupers. Weights often have 4 significant digits.

You can borrow information from other states

Since you are using the same weight sets as other states you can take advantage of the material published by other 48 grouper states. Obviously you want to be careful here, but feel free to see if other states have created a grouper walkthrough or decision tree that you find easier to use. Here’s a nice one the state of Wisconsin made. Thanks Wisconsin! Here’s another one from Mississippi courtesy of Meyers and Stauffer. It’s much longer but maybe it’s more appropriate for you. Here’s one from Indiana. This is one you should use more caution with since Indiana time-weights.

You can ask for help

While case-mix might be new to Tennessee, it’s been around a long time in other states. Seek out counsel from experienced people. There are plenty of people out there that like to help. Feel free to contact me.