1. (1) TennCare shall periodically review the documentation maintained by nursing facilities for all residents, regardless of payer type, for purposes of the MDS Case-Mix Review. The MDS Case-Mix Reviews shall be conducted as frequently as deemed necessary by TennCare, and each nursing facility shall be reviewed no less frequently than every thirty-six (36) months. Advance notification of up to forty-eight (48) hours shall be provided by the reviewer for all MDS Case-Mix Reviews, except for follow-up reviews that are intended to ensure compliance with validation improvement plans. Advance notification for follow-up reviews shall not be required.
2. (2) When conducting the MDS Case-Mix Reviews, TennCare shall consider all documentation that is provided by the nursing facility and is available to the reviewers prior to the exit conference. Documentation that is provided by the nursing facility after the exit conference begins shall not be considered by TennCare.

Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413. Administrative History: New rule filed March 31, 2026; effective June 29, 2026.