D.C. Mun. Regs. tit. 29, r. 29-6504
DHCF shall use the forty-eight (48)-group resident classification system developed by CMS known as the Resource Utilization Groups IV (RUGS IV), Version 1.03 or successor updates.
DHCF shall use the Case Mix Indices known as the standard data set F01 developed by CMS or successor updates to this version.
Each resident assessed under RUGS shall be assigned the highest numeric case mix index (CMI) score for which the resident qualifies. Assessments that cannot be classified to a RUGS IV category due to errors shall be assigned the category with the lowest numeric CMI score.
The most recent valid MDS assessment for the resident shall be used by the nursing facility when submitting the RUG category on the claim for services.
The RUG category shall be included on the claim for services as a valid Health Insurance Prospective Payment System (HIPPS) code.
The CMI for the submitted RUG category will be used to adjust the nursing and resident care portion of the facility specific per diem during claims adjudication.
If subsequent review of the medical record, or the MDS reveals that the RUG category submitted as a HIPPS code on the claim is incorrect, the claim will be reprocessed with the appropriate HIPPS code, RUG category, and CMI.
D.C. Mun. Regs. tit. 29, r. 29-6504