Recently, there have been an increasing number of questions concerning the Acuity Scale that the Bureau of TennCare is using for the TennCare Long-Term Care (LTC) delivery system.  The information that will be reviewed here is mainly taken from the RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE CHAPTER 1200-13-01 TENNCARE LONG-TERM CARE PROGRAMS , which is available at the following link http://www.tn.gov/sos/rules/1200/1200-13/1200-13-01.20120629.pdf.  A somewhat shorter description in available in The Nursing Facility Level of Care (LOC) Guide For TennCare CHOICES and PACE is included in the following link http://www.tn.gov/tenncare/forms/nflocguide.pdf.

TennCare Nursing Facility Level of Care Acuity Scale

The Maximum possible Total Nursing Facility Level of Care acuity score (total NF LOC acuity score) is 26.

This can be expressed as:

Total NF LOC acuity score = Acuity score for Activities of Daily Living (ADL) or related deficiencies + Acuity score for skilled and/or rehabilitative services.

 

The Acuity score for Activities of Daily Living(ADL) or related deficiencies is derived from the chart found on page 105 from the RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE CHAPTER 1200-13-01 TENNCARE LONG-TERM CARE PROGRAMS

An explanation of  the headings  in the first column and first row precedes this table in the TennCare document.    To summarize:

Transfer and Mobility are grouped together, with the highest value of the two measures being used for the acuity score.

Transfer:  The ability of an individual to transfer to and from bed, chair or toilet

Mobility: The ability to walk, using mobility aids such as a walker, crutch, or cane if required, or the ability to use a wheelchair if walking is not feasible.

Eating: The ability to eat.  Food preparation, tray set-up, and assistance in cutting up foods is not included.  Feeding tubes appear to be a somewhat special case.

Toileting: The ability to perform toileting activities, including the ability of performance of incontinence care, ostomy care, indwelling catheter care.  This area is broken up into 3 areas, with only the highest value for the 3 areas being taken into account.  Toilet in general has a potential maximum value of 2, while Incontinence  care and Catheter/ostomy care have a potential maximum value of 3.

Orientation:  The individual’s ability to be oriented to person or place.

Expressive communication and Receptive communication are grouped, with the highest value of two questions for the communication measure being used.  The ability for the individual to reliably communicate basic needs and wants (e.g. need for assistance with toileting, presence of pain using verbal or written language), and the ability to understand and follow very simple instructions and commands (e.g., how to perform or complete basic activities such as dressing or bathing),

 

Self-administration of medication: The individual is not mentally or physically capable of self-administering prescribed medications despite the availability of limited assistance from another person. Limited assistance includes, but is not limited to, reminding when to take medications, encouragement to take, reading medication labels, opening bottles, handing to individual, and reassurance of the correct dose.

 

From Page 107 of the RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE CHAPTER 1200-13-01 TENNCARE LONG-TERM CARE PROGRAMS:

 

(iv) Maximum Acuity Score for Self-Administration of Medication

 

(I) Assessment of the applicant’s level of independence (or deficiency) with self-administration of medications as an ADL-related function shall not take into consideration whether the applicant requires sliding scale insulin and the applicant’s level of independence in self administering sliding scale insulin.

(II) Sliding scale insulin shall be considered along with other skilled and/or rehabilitative services for which TennCare could authorize level 2 NF reimbursement.

(III) The maximum individual acuity score for self-administration of medication shall be two (2).

(IV) The maximum individual acuity score for sliding scale insulin shall be one (1).

From rhat.org

The next item is the Behavior rating.  This has a maximum score of 3. Behavior – The individual requires persistent intervention (daily or at least four days per week) due to an established and persistent pattern of dementia-related behavioral problems (e.g., aggressive physical behavior, disrobing, or repetitive elopement).

Interpretation of possible responses for the behavior measure

(i) “Always” shall mean that the applicant always requires intervention for

dementia-related behaviors.

(ii) “Usually” shall mean that the applicant requires intervention for dementia related

behaviors 4 or more days per week.

(iii) “Usually not” shall mean that the applicant requires intervention for

dementia-related behaviors, but fewer than 4 days per week.

(iv) “Never” shall mean that the applicant does not have dementia-related

behaviors that require intervention.

 

Acuity score for skilled and/or rehabilitative services is the last component of the Total Nursing Facility Level of Care acuity score.  It has a possible maximum score of 5.  The table below is taken from page 105 of  the RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE CHAPTER 1200-13-01 TENNCARE LONG-TERM CARE PROGRAMS.

To review:

The Maximum possible Total Nursing Facility Level of Care acuity score (total NF LOC acuity score) is 26.

This can be expressed as:

Total NF LOC acuity score(maximum possible score of 26) = Acuity score for Activities of Daily Living (ADL) or related deficiencies(maximum possible score of 21) + Acuity score for skilled and/or rehabilitative services(maximum possible score of 5).