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Enhancement to RUG Calculator for MDS Assessments Available June 3, 2024

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Texas Health and Human Services (HHS) and the Texas Medicaid & Healthcare Partnership (TMHP) have identified a calculation error in the Minimum Data Set (MDS) Resource Utilization Group (RUG) calculation on the Long-term Care Online Portal (LTCOP). The error occurs when C0100 equals “1” (“Yes, and”) and C0500 equals “-” (“no information”).

The Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual instructs nursing facilities (NFs) not to complete the Staff Assessment for Mental Status items (C0700–C1000) if the resident interview should have been conducted but was not. This combination of data is causing the RUG calculator to add an additional point to the resident’s severity score, resulting in incorrect RUG classifications of SE2 or SE3 instead of SE1 or SE2.

An enhancement has been deployed to prevent this error. Long-Term Care Medicaid Information (LTCMI) and Section RUG submissions made on or after June 3, 2024, will be processed with the correct RUG calculations.

Action Required

To ensure correct payment, the RUG calculator must be retriggered for MDS assessments with an Assessment Reference Date of October 1, 2023, or later, which meets the above criteria. To retrigger RUG calculations:

  1. Use the Correct this form function on the LTCOP.
  2. Add a statement in the LTCMI comment section indicating the need for correction.
  3. Do not modify any other data in Section LTCMI or Section RUG.
  4. A new Document Locator Number (DLN) will be generated, and the new DLN will proceed through the normal validation and verification processes.

Third-party LTCMI software users will use the correction process within those applications.

HHS and TMHP are developing a process to systematically correct all affected MDSs, which will be deployed this summer. Any uncorrected MDSs will be systematically corrected at that time, and an additional notification will be published.