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TennCare updates nursing-facility reimbursement rules to adopt PDPM and QUILTS
Summary
TennCare presented amendments adopting the patient-driven payment model (PDPM), adding MDS case-mix review provisions and setting QUILTS quality-benchmark publication procedures; committee approved the rules with a positive recommendation after clarifying how benchmarks will be published and revised.
Amanda Petri, associate counsel for TennCare, presented a rule package that adds PDPM definitions, clarifies MDS (Minimum Data Set) case-mix review processes and penalties for unsupported resident assessments, and incorporates the QUILTS methodology for quality-based reimbursement. Petri said the QUILTS scoring and performance-benchmark methodology will be published in an annual QUILTS memo and the manual is posted on the agency website.
Members asked why the detailed scoring benchmarks are not in the rules; TennCare said the manual is voluminous and published to permit timely updates, and Katie Evans (director of long-term services & supports) added that benchmarks are usually updated in response to federal metric changes or stakeholder discussions. After questions and no public comments, the committee moved a positive recommendation and the rules advanced.
