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Clinical RUG-IV

RUG Qualifiers &

Length of Stay

Part 1

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RUG Qualifiers & Length of Stay: Part 1

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POST TEST

1. Three of the four ADLs need to be Extensive to achieve an ADL end split of B?

a. True

b. False

2. Therapy end date in Section O indicates which of the following?

a. The last day that therapy was provided is the end date

b. This is the first day billed at non-therapy rate

c. All of the above

3. Which of the following statements are accurate related to therapy days and minutes in Section O?

a. You can round units to minutes

b. Group minutes should be coded as concurrent minutes on MDS

c. You cannot include evaluation time in minutes

d. All of the above

4. Which of the following are accurate statements?

a. PHQ-9 score may impact RUG end splits

b. BIMS score impacts qualifiers for Cognitive/Behavior RUG

c. Cognitive Performance Scale (CPS) score can also impact RUG if resident is non-interviewable

d. All of the above



POST TEST ANSWERS

1. Three of the four ADLs need to be Extensive to achieve an ADL end split of B?

a. True

b. False

True

2. Therapy end date in Section O indicates which of the following?

a. The last day that therapy was provided is the end date

b. This is the first day billed at non-therapy rate

c. All of the above

A

3. Which of the following statements are accurate related to therapy days and minutes in Section O?

a. You can round units to minutes

b. Group minutes should be coded as concurrent minutes on MDS

c. You cannot include evaluation time in minutes

d. All of the above

C

4. Which of the following are accurate statements?

a. PHQ-9 score may impact RUG end splits

b. BIMS score impacts qualifiers for Cognitive/Behavior RUG

c. Cognitive Performance Scale (CPS) score can also impact RUG if resident is non-interviewable

d. All of the above

D


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RUGs Part 1:

RUG Categories & Qualifiers & LOS

1


Definitions

• Minimum Data Set (MDS)

• PPS – Prospective Payment System is the payment system using the RUG category for payment

• Resource Utilization Group (RUG)

– Payment is determined by the resources needed to care for a resident as coded on MDS.

– The RUG-IV is a classification based on residents’ clinical condition and the extent of services needed and provided.

• Grouper – Software which determines RUG classification

2



3

RUG-IVReview

See RUG-IV coding detail


RUG-IV Classification System

8 Categories – Rehab Plus Extensive (9)– Rehab (14)– Extensive Services (3)– Special Care High (8)– Special Care Low (8)– Clinically Complex (10)– Behavior Symptoms &

Cognitive Performance (4)– Reduced Physical

Functioning (10)

“automatically” meets Skilled LOC

from first MDS (5-day) up

through ARD

66 RUGs

4



RUG-IV 66 Group Model Calculation

5


RUG-IV 66 Group Model Calculation

6



• Index Maximization

– Grouper looks at all possible groups and picks the RUG with the highest Case Mix Index (CMI)

– Used for RUG-IV Medicare

– Nursing and Therapy Index Together = CMI

– Medicare is Index Maximizing

• Hierarchical Classification

– The first group the resident qualifies in

CMI and RATES

7


Payment Rate Changes Oct. 1, 2015

• Based on proposed changes, CMS projects that aggregate payments to SNFs will increaseby $750 million, or 2.0%, from payments in FY 2014

• Represents a higher update factor than the 1.3% update finalized for SNFs last year.

8



RUG-IV CMI Maximizing

First Letter = RUG category

Second Letter = therapy level or ADL

Level

Third letter = ADL end split or other end split.

9

RUG-IV URBAN FY 2016 (Eff. Oct 1, 2015) Maximizing

Case-Mix Adjusted Federal Rates and Associated Indexes

RUG-IVCategory

Nursing Index

Therapy Index

Nursing Component

Therapy Component

Non-case Mix Therapy Comp

Non-case Mix Component

Total Rate CMI

RUX 2.67 1.87 $457.02 $241.12 $86.36 $785.50 66

RUL 2.57 1.87 $439.91 $241.12 $86.36 $768.39 65

ES3 3.58 $612.79 $16.98 $86.36 $717.13 64

RVX 2.61 1.28 $446.75 $165.04 $86.36 $699.15 63

RHX 2.55 0.85 $436.48 $109.60 $86.36 $633.44 62

RVL 2.19 1.28 $374.86 $165.04 $86.36 $627.26 61

RUC 1.56 1.87 $267.03 $241.12 $86.36 $595.51 60

RUB 1.56 1.87 $267.03 $241.12 $86.36 $595.51 59

RMX 2.47 0.55 $422.79 $70.92 $86.36 $581.07 58

RHL 2.15 0.85 $368.02 $109.60 $86.36 $564.98 57

ES2 2.67 $457.02 $16.98 $86.36 $561.36 56

RML 2.19 0.55 $374.86 $70.92 $86.36 $533.14 55

RVC 1.51 1.28 $258.47 $165.04 $86.36 $510.87 54

RLX 2.26 0.28 $386.84 $36.10 $86.36 $510.30 53

ES1 2.32 $397.11 $16.98 $86.36 $501.45 52

RUA 0.99 1.87 $169.46 $241.12 $86.36 $497.94 51

HE2 2.22 $380.00 $16.98 $86.36 $484.34 50

HD2 2.04 $349.19 $16.98 $86.36 $453.53 49

RHC 1.45 0.85 $248.20 $109.60 $86.36 $445.16 48

RVB 1.11 1.28 $190.00 $165.04 $86.36 $442.40 47

RVA 1.10 1.28 $188.29 $165.04 $86.36 $440.69 46

LE2 1.96 $335.49 $16.98 $86.36 $439.83 45

HC2 1.89 $323.51 $16.98 $86.36 $427.85 44

HB2 1.86 $318.38 $16.98 $86.36 $422.72 43


RUG-IV CMI Maximizing (continued)

10

LD2 1.86 $318.38 $16.98 $86.36 $422.72 42

HE1 1.74 $297.84 $16.98 $86.36 $402.18 41

RHB 1.19 0.85 $203.69 $109.60 $86.36 $400.65 40

CE2 1.68 $287.57 $16.98 $86.36 $391.91 39

RMC 1.36 0.55 $232.79 $70.92 $86.36 $391.07 38

RLB 1.50 0.28 $256.76 $36.10 $86.36 $380.22 37

HD1 1.60 $273.87 $16.98 $86.36 $378.21 36

LC2 1.56 $267.03 $16.98 $86.36 $371.37 35

CD2 1.56 $267.03 $16.98 $86.36 $371.37 34

LE1 1.54 $263.60 $16.98 $86.36 $367.94 33

RMB 1.22 0.55 $208.83 $70.92 $86.36 $367.11 32

CE1 1.50 $256.76 $16.98 $86.36 $361.10 31

PE2 1.50 $256.76 $16.98 $86.36 $361.10 30

HC1 1.48 $253.33 $16.98 $86.36 $357.67 29

HB1 1.46 $249.91 $16.98 $86.36 $354.25 28

LD1 1.46 $249.91 $16.98 $86.36 $354.25 27

RHA 0.91 0.85 $155.76 $109.60 $86.36 $352.72 26

LB2 1.45 $248.20 $16.98 $86.36 $352.54 25

PE1 1.40 $239.64 $16.98 $86.36 $343.98 24

CD1 1.38 $236.21 $16.98 $86.36 $340.55 23

PD2 1.38 $236.21 $16.98 $86.36 $340.55 22

CC2 1.29 $220.81 $16.98 $86.36 $325.15 21

PD1 1.28 $219.10 $16.98 $86.36 $323.44 20



RUG-IV CMI Maximizing (continued)

11

LC1 1.22 $208.83 $16.98 $86.36 $313.17 19

RMA 0.84 0.55 $143.78 $70.92 $86.36 $302.06 18

CC1 1.15 $196.85 $16.98 $86.36 $301.19 17

CB2 1.15 $196.85 $16.98 $86.36 $301.19 16

LB1 1.14 $195.13 $16.98 $86.36 $299.47 15

PC2 1.10 $188.29 $16.98 $86.36 $292.63 14

CB1 1.02 $174.59 $16.98 $86.36 $278.93 13

PC1 1.02 $174.59 $16.98 $86.36 $278.93 12

BB2 0.97 $166.03 $16.98 $86.36 $270.37 11

BB1 0.90 $154.05 $16.98 $86.36 $258.39 10

CA2 0.88 $150.63 $16.98 $86.36 $254.97 9

PB2 0.84 $143.78 $16.98 $86.36 $248.12 8

RLA 0.71 0.28 $121.53 $36.10 $86.36 $244.99 7

CA1 0.78 $133.51 $16.98 $86.36 $237.85 6

PB1 0.78 $133.51 $16.98 $86.36 $237.85 5

BA2 0.70 $119.82 $16.98 $86.36 $224.16 4

BA1 0.64 $109.55 $16.98 $86.36 $213.89 3

PA2 0.59 $100.99 $16.98 $86.36 $205.33 2

PA1 0.54 $92.43 $16.98 $86.36 $196.77 1


ADL Coding and Score

3 or more rule!!!Difference between ADL end-splits can be over $100 a day

12



13


14



ADL Tracking

15

36 37 38 39 40 41 42

36 37 38 39 40 41 42

36 37 38 39 40 41 42

2/2 2/2 2/2 3/2 3/3

3/2

2/2 2/2

3/2 3/3 3/2 2/2 2/2 3/2

1/1 1/1 3/2 2/2 2/2 1/1 1/1


ADL Scoring –Score range from 0 - 16

Self Performance: Column 1• Code 0, independent• Code 1, supervision• Code 2, limited assist• Code 3, extensive assist• Code 4, total dependence• Code 7, activity occurred only once

or twice• Code 8, activity did not occur

Staff Support: Column 2

• Code 0, no setup or physical help from staff

• Code 1, setup help only

• Code 2, one person physical assist

• Code 3, two+ person physical assist

• Code 8, activity did not occur

ADL Scoring for Bed Mobility, Transfer and Toilet Use

Self Performance

Column 1

Staff Support

Column 2

ADL Score

--, 0, 1, 7, or 8 and (any number)

0

2 and (any number)

1

3 and --, 0, 1, 2 2

4 and --, 0, 1, 2 3

3 or 4 and 3 4

16



ADL Scoring –Score range from 0 - 16

Self Performance: Column 1• Code 0, independent• Code 1, supervision• Code 2, limited assist• Code 3, extensive assist• Code 4, total dependence• Code 7, activity occurred only once

or twice• Code 8, activity did not occur

Staff Support: Column 2

• Code 0, no setup or physical help from staff

• Code 1, setup help only

• Code 2, one person physical assist

• Code 3, two+ person physical assist

• Code 8, activity did not occur

ADL Scoring for Eating

Self Performance

Column 1

Staff Support

Column 2

ADL Score

--, 0, 1, 2, 7, or 8 and --, 1, or 8 0

--, 0, 1, 2,7, or 8 and 2 or 3 2

3 or 4 and --, 0, or 1 2

3 and 2 or 3 3

4 and 2 or 3 4

17


18

2 2

2 2

1 1

3 2

RUG-IV ADL Score #1

• Bed Mobility

• Transfers

• Eating

• Toilet Use

Self

Performance

1

1

0

2

Support

RUG-IV ADL Score = 4 (A)

RUG-IV



19

3 2

3 2

1 1

3 2

RUG-IV ADL Score #1

• Bed Mobility

• Transfers

• Eating

• Toilet Use

Self

Performance

2

2

0

2

Support

RUG-IV ADL Score = 6 (B)

RUG-IV


ADL Case Studies

20



ADL Scores

2nd

Quarter 2015

1st

Quarter 2015

4th

Quarter 2014

3rd

Quarter 2014

2nd

Quarter 2014

ADL Level % % % % %

X 1.12 1.04 0.94 0.91 1.03L 0.96 0.91 0.76 0.70 0.78C 33.31 33.19 33.30 32.76 33.20B 39.22 40.46 38.52 38.76 38.26A 25.39 24.39 26.48 26.87 26.74

* Source Polaris Group KIT Database 21


ADL Scores

• Identifies MDS Coordinator training needs

• Identifies documentation deficiencies

• Revenue between an “A” and a “C” can be over $100 a day

22



ADL Data Gathering

ADL data gathering - score of “6” to achieve “B”

– 3 out of 4 ADLs need to be Extensive Assist

• Data gathering “By Shift” limits total “events”

– May have only two “shifts” with Extensive for an ADL

• Interview staff; likely ext. assist was provided 3 or more times during look back – chart to true “number of times.”

– Collect ADL Data gathering to “by event”

• If transfer 3 times on one shift, capture all 3 times.

23


• Have formal data gathering methods for Medicare residents.

• Have formal data gathering systems for OBRA Initial, Quarterly, and Annual Assessments as well as Significant Clinical Change Assessments, especially needed if a Case Mix State.

• Ideas to limit “copycat” charting: Have data sheets separated for each shift, consider having worksheets turned in at the end of the shift. Nurse then transfers to flow sheet like vital signs.

• May consider self-performance and support in therapy when coding Section G.

24

Documentation for Section G




• If the MDS Nurse is going to code ADLs on the MDS in conflict with medical record documentation, then a summary note of findings should be written in the clinical record.

• Implement MDS ADL training for aides, nurses, and MDS Nurse in orientation with competency test.

• Implement a MDS cheat sheet for new hires and temporary agency staff for quick reference.

• Post MDS/ADLs related posters and signs to serve as ongoing fun reminders.

25



• Provide inservices every 3 months on MDS and related ADLs.

• Allow time for aides to document; get rid of any unnecessary documentation.

26



2727

Therapy’s Role in ADL Scoring

• Consider therapy documentation if needed to find a 3rd

Extensive.

• ADLs are clearly part of a therapy plan and the levels of assistance can be a component of the discussions with the MDS Coordinator following the Rule of Three.

• Provide feedback regarding the late loss ADLs as noted during therapy sessions in the last 7 day; consideration will always be towards scoring the most dependent status.

• Therapy documentation will provide continued support for late loss ADLs through daily and weekly notes.


Nursing (MDS Definitions) Crosswalk to TherapyIndependent

No help or staff oversight

Independent

Supervised

Oversight, encouragement, or cueing provided (no hands on)

Supervised

Stand-by assist without touching

Limited Assistance

Physical help in guided maneuvering of limbs or other non weight-bearing assistance

Contact Guard

Stand-by assist with touching but no weight-bearing

Extensive Assistance

Weight bearing support provided by staff

Minimum Assistance (some weight bearing support)

Moderate Assistance

Maximum AssistanceTotal Dependence

Full Staff Performance of the activity

Dependent or NT – Not tested for Dependence 28



Rehab Plus Extensive

29


Rehab Plus Extensive RUG Level

• Ultra High Rehab– 720+ minutes during observation period– at least 2 disciplines: 1 for 5 days,– and a second discipline for 3 days– Or, Medicare Short Stay Indicator = Yes

• Average minutes 144 or more– Qualifies for Extensive

ADL Split RUX – 11-16RUL – 2 - 10

30




• Very High Rehab

– 500+ minutes during observation period

– 1 discipline for 5 days

– Or Medicare Short Stay Indicator = Yes

• Average minutes 100-143

– Qualifies for Extensive

ADL Split – RVX – 11-16

RVL – 2-10 31



• High Rehab



– Or, Medicare Short Stay Indicator = Yes


Qualifies for Extensive

ADL Split RHX – 11-16

RHL – 2-10 32




• Medium Rehab


– And 5 distinct calendar days


• Average Minutes 30-64


ADL Split RMX – 11-16

RML – 2-10

33



• Low Rehab

– 45+ minutes of therapy

– And 3 distinct calendar days

– 2+ nursing rehab activities, at least 15 minutes/day for 6+ days

– Or, Medicare Short Stay Indicator = yes

• Average minutes 15- 29


ADL Split RLX – 2-1634




• Nursing Restorative Qualifiers

– Urinary or bowel toileting program** (Section H)

– Passive and/or active ROM**

– Splint or brace assistance

– Bed mobility and/or walking training**

– Transfer training

35

– Dressing and/or grooming training

– Eating and/or swallowing training

– Amputation/ prosthesis care

– Communication training

** Count as one service even if both provided


Changes to Rehab Medium and Low Qualifier

36

• ARD would determine past 7 days.



Rehab Medium and Low Qualifier

Daily Skilled Service:

• 5 distinct days a week for therapy to be considered skilled.– Not Daily: PT – M, W, F, and OT – M, W

– Must be 5 distinct days

• Must be 5 distinct days, for example:– PT is scheduled 3 days each week (M, W, F)

– OT is scheduled 2 other days each week (T, Th)

37


Rehab Medium and Low Qualifier

Daily Skilled Service:

• Requires a legitimate medical need for scheduling a therapy session each day or the “daily basis” requirement for skilled coverage.

• The basic issue here is not whether the services are needed, but when they are needed.

• No indication yet what this means to Short Stay qualifiers.

38



39

Extensive


40



Extensive

• Tracheostomy care while a resident

• Ventilator/respirator while a resident

• Isolation for Active Contagious Disease while a resident

41


Strict Isolation

• Code only when the resident requires transmission-based precautions and strict isolation alone in a separate room because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

42



Strict Isolation

• Do not code this item if the resident only has a history of infectious disease (e.g., s/p MRSA or s/p C-Diff - no active symptoms).

• Do not code this item if the precautions are standard precautions, because these types of precautions apply to everyone. Standard precautions include hand hygiene compliance, glove use, and additionally may include masks, eye protection, and gowns.

43


Strict Isolation

Code for “strict isolation” only when all of the following conditions are met:

1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

2. Precautions are over and above standard precautions. That is transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

44



Strict Isolation

Code for “strict isolation” only when all of the following conditions are met:

3. The resident is in a room alone because of active infection and cannot have a roommate. Cannot cohort even with a resident with similar infection.

4. The resident must remain in his/her room. (This requires that services be brought activities, dining, etc.).

45


Isolation Coding

• Examples of when the isolation criterion would not apply include urinary tract infections, encapsulated pneumonia, and wound infections.

• Physician documentation to support diagnosis and isolation.

• Care plan address IC practices.

• Care plan is updated as needed and consider SCSA.

• Train therapy staff as indicated for resident’s condition.

46



Extensive

• ADL Score of 2 or greater

– ADL score of 0-1 Classifies for Clinically Complex

• End-Splits

– 3 = Trach care & ventilator/respirator - ES3

– 2 = Trach care or ventilator/respirator – ES2

– 1 = Isolation for active infectious disease – ES1

– Without Trach and Vent

47


48



Section O – Special Treatments and Procedures

49

• To be coded on MDS; therapy services would be skilled services

– Would not code therapy provided upon request of resident that is not skilled or maintenance

• Mode of each therapy received

• Residents time in therapy (which includes respiratory therapy)

• Number of minutes and number of days

• Include only therapy provided once living/being cared for in facility or readmitted


O0400 – Therapy

1. Individual Minutes

2. Concurrent Minutes

3. Group Minutes

Grouper will use sum of individual, concurrent, and group minutes to determine total RUG minutes

4. Total number of days at least 15 minutes or more considering all types of minutes. Consider ALL concurrent minutes


50



Counting minutes• Count only minutes since admission• Do not round minutes • Do not count evaluation minutes or documentation

minutes • Re-evaluation minutes count • Therapy Assistants can count per state oversight• Family education can count if resident is present

and documented


51


Counting minutes• Therapy Aides cannot provide skilled services

beyond set up minutes• Setting up minutes do count• Transport minutes do not count• Co-treatment – full resident minutes can be

coded for each discipline as individual minutes • Therapy Students can count within line of sight


52




• Count/Code Resident Time in Therapy for each type of activity

• Individual Minutes Medicare Part A – All Individual resident therapy minutes count - one

therapist or assistant to one resident– Co-treatments code as individual minutes

53



• Concurrent Therapy Medicare Part A– All concurrent minutes count toward daily minutes – Two residents treated at same time by one

therapist/assistant– Each resident is performing different activities– Regardless of payer source, if one resident is Part A, it

applies to Part A resident in terms of coding on MDS.– Both residents must be within line of sight of

therapist/assistant– Concurrent minutes do not need to be in clarification

order 54




• Under RUG-IV for Part A

– Concurrent Minutes• Grouper will allocate only half of the concurrent minutes

toward a therapy RUG category

• Resident concurrent minutes are 30; allocated minutes used for RUG is 15 minutes- divided in half by grouper

• Resident was in therapy for 46 minutes; 46 minutes are coded on MDS in Concurrent Therapy. The Grouper will only count 23 minutes toward RUG

• Grouper rounds mathematically up or down. 33 min = 16.5. 17 minutes used for grouper

55



• Group Minutes Medicare Part A

– Group of 2-4 perform similar activities with one treating therapist or assistant

– Group minutes should be in clarification order

56




• Group Minutes Medicare Part A

– Group of 4 perform similar activities with one treating therapist or assistant.

– Only 25% of Resident minutes contribute to RUG.

– Capped at 25% of total reimbursable minutes for each discipline

– Group minutes should be in clarification order

57


Group Minutes

• Impact:

– Groups must be planned for 4 residents. • 30 minutes with 4 residents; is 30 minutes on each

resident’s MDS.

– However, only 7.5 (8) minutes is considered RTM by grouper to calculate RUG.

– Only 8 minutes is used to calculate the 25% cap.

• If one or two residents “miss” planned 4 person group therapy, SNF may still code as group minutes on MDS, and allocation still applies.

58



Co-Treatment Item

• Co-treatment minutes are coded as individual minutes.

• If there is one discipline with co-treatment minutes, there would have to be a second with co-treatment minutes.

• These minutes would match.

• No indication this item will impact RUG calculations.

59


Co-Treatment Coding Example

• PT delivered 221 individual minutes over the last 7 days. Of those individual minutes, 101 were co-treatment minutes with OT. – Code 221 Individual Minutes

– Code 101 Co-treatment Minutes

• OT delivered 101 individual minutes over last 7 days. Of those individual minutes, all were co-treatment minutes with PT. – Code 101 Individual Minutes

– Code 101 Co-treatment Minutes. 60



5. Therapy Start date – first day therapy started

– Start of Therapy – Rehab RUG billed first day with therapy

– Day Evaluation done even if treatment not provided

6. Therapy End date - End of Therapy – This is the last day of therapy date. (CMS ongoing clarifications)

– A non-therapy/Medical RUG is billed the first day without therapy

Carry Start and End dates over to subsequent MDS


61


Therapy End Date

Therapy End Date – “Record the date the most recent therapy regimen (since the most recent entry) ended. This is the last date the resident received skilled therapy treatment. Enter dashes if therapy is ongoing.”

Scenario One: End of Therapy date is planned. Once the last therapy is discontinued/end date is last day received; and resident stays on Part A for another skilled service; an End of Therapy MDS must be completed to bill Medical RUG.

Scenario Two: Resident is on Part A, still on case load, when unexpectedly discharged.

62



Rehab Category

63


Rehab RUG Level

• Ultra High Rehab


– at least 2 disciplines: 1 for 5 days,

– and a second discipline for 3 days


• Average minutes 144 or more

ADL Split RUC – 11 - 16

RUB – 6 - 10

RUA – 0 - 5 64



Rehab RUG Level

• Very High Rehab– 500+ minutes during observation period– 1 discipline for 5 days– Or Medicare Short Stay Indicator = Yes


ADL Split – RVC – 11-16RVB – 6-10 RVA – 0-5

65


Rehab RUG Level

• High Rehab





ADL Split RHC – 11-16

RHB – 6-10

RHA – 0-566



Rehab RUG Level

• Medium Rehab


– 5 Distinct Calendar Day


• Average Minutes 30-64

ADL Split RMC – 11-16

RMB – 6-10

RMA – 0-5

67


Rehab RUG Level

• Low Rehab

– 45+ minutes of therapy

– 3 Distinct Calendar days

– 2+ nursing rehab activities, at least 15 minutes/day for 6+ days

– Or, Medicare Short Stay Indicator = yes

• Average minutes 15 - 29

ADL Split RLB – 11-16

RLA – 0-1068



Nursing Restorative






– Transfer training69



– Amputation/prosthesis care




Rehab RUGs and Therapy Minutes

70



71


Special Care High

72



Special Care High

• Comatose & 4 ADL = 4 or 8

• Septicemia

• Diabetes with daily insulin injections and Insulin order change on 2 or more days

• Quadriplegia with ADL score >=5

• Chronic obstructive pulmonary disease and Shortness of breath when lying flat; – Other diagnosis can be coded for I6200

73


Special Care High

• Fever with pneumonia, vomiting, Feeding tube (calories >= 51% or calories = 26-50% and fluid >= 501cc) – coding “during the entire last 7 days” or weight loss

• Parenteral/IV feedings “During Entire Last 7 Days” apply to RUG

• Respiratory therapy for 7 daysAND

• ADL score of 2 or moreEnd – Splits

2 = Signs of Depression PHQ-9 Score >=10 1 = Without Depression 74



Special Care High Mood Indicators

D0200A D0500A Little interest or pleasure in doing things D0200B D0500B Feeling down, depressed, or hopeless D0200C D0500C Trouble falling/staying asleep, sleeping tooD0200D D0500D Feeling tired or having little energy D0200E D0500E Poor appetite or overeating D0200F D0500F Feeling bad or failure or let self or othersD0200G D0500G Trouble concentrating on things D0200H D0500H Moving or speaking slowly or being fidgetyD0200I D0500I Thoughts better off dead or hurting self

D0500J Short-tempered, easily annoyed

Res. Staff Description

75


Special Care HighDepression Score

PHQ-9© Total Severity Score can be used to track changes in severity over time. Total Severity Score can be interpreted as follows: Scale is 0-27 for interview and 0-30 for observations.

Applied to Interview or Observations1-4: minimal depression 5-9: mild depression 10-14: moderate depression 15-19: moderately severe depression 20-27(30): severe depression

76



Special Care High

ADL Score Depressed RUG-IV Class

15-16 Yes HE2

15-16 No HE1

11-14 Yes HD2

11-14 No HD1

6-10 Yes HC2

6-10 No HC1

2-5 Yes HB2

2-5 No HB1 77


Special Care Low

78



Special Care Low

• ADL score of 2 or moreAND • Cerebral Palsy, • Multiple Sclerosis, • Parkinson’s Disease with ADL score >=5; • Respiratory failure and oxygen while a resident; • Feeding tube (calories >= 51% or calories = 26-50% and fluid >= 501cc) – coding “during the entire last 7 days” average across last 7 days.

79


Item Changes Related to Tube & Parenteral Feedings

80



Special Care Low

• 2+ stage 2 pressure ulcers with 2+ skin treatments**

• Stage III or IV pressure ulcer with 2+ skin treatments**

• 2+ venous/arterial ulcers with 2+ skin treatments**

• 1 stage 2 pressure ulcer and 1 venous/arterial ulcer with 2+ skin treatments**

81


Special Care Low

• Skin Treatments**

• Pressure relieving chair and/or bed*

• Turning/repositioning

• Nutrition or hydration interventions

• Ulcer care

• Dressing (not to foot)

• Ointments (not to foot)

* Count as one treatment even if both provided

82



Special Care Low

• Foot infection/diabetic foot ulcer/open lesions of foot with treatment**

** Application of dressing to foot • Radiation therapy while a resident;• Dialysis while a resident

End – Splits2 = Signs of Depression PHQ-9 Score >=101 = Without Depression

83


Special Care Low

ADL Score Depressed RUG-IV Class

15-16 Yes LE2 15-16 No LE1 11-14 Yes LD2 11-14 No LD1 6-10 Yes LC2 6-10 No LC1 2-5 Yes LB2

2-5 No LB184



Clinically Complex

85


Clinically Complex

• Extensive Services, Special Care High or Special Care Low qualifier and ADL score of 0 or 1

OR• Pneumonia; • Hemiplegia with ADL score >=5;

• Surgical wounds or open lesions with treatment; – Selected Skin Treatments

• M1200F Surgical wound care • M1200G Application of dressing (not to feet) • M1200H Application of ointments (not to feet)

86



Clinically Complex

• Burns;• Chemotherapy while a resident; • IV medications while a resident; • Oxygen therapy while a resident; • Transfusions while a resident

End – Splits 2 = Signs of Depression PHQ-9 Score >=101 = Without Depression

87


Clinically Complex

ADL Score Depressed RUG-IV Class 15-16 Yes CE2 15-16 No CE1 11-14 Yes CD2 11-14 No CD1 6-10 Yes CC2 6-10 No CC1 2-5 Yes CB2 2-5 No CB1 0-1 Yes CA2 0-1 No CA1

88



Behavior Symptoms andCognitive Performance

89


Behavior Symptoms and Cognitive Performance

• ADL score of <=5• Qualify for Cognitive Impairment CPS>=3 OR BIMS <=9 • OR Qualify for Behavior Symptoms at least one of the

following: – Hallucinations or Delusions or– One occurring on 4 or more days:

• Physical behavioral symptoms directed toward others • Verbal behavioral symptoms directed toward others • Other behavioral symptoms not directed toward

others • Rejection of care • Wandering

90



Cognitive Performance BIMS

C0500 – Add scores 00 - 15 Add up numerical value of coding of each item in the interview: Qualifies if <=9

The BIMS total score is highly correlated with Mini-Mental State Exam; suggest the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment

91


92



Behavior Symptoms andCognitive Performance

ADL Score

2 – 5

2 – 5

0 – 1

0 – 1

Restorative Nursing

2 or more

0 – 1

2 or more

0 – 1

RUG-IV

BB2

BB1

BA2

BA1

93


94

Physical Functioning

• Reduced Physical Functioning (10)

– Only changes with ADL score/splits

– Nursing restorative qualifiers remain the same




95


Nursing Restorative






– Transfer training

96



– Amputation/prosthesis care






Nursing Rehab. Services

ADL Index Score: 0 or 1 2 or More

0 - 1 = PA PA1 PA2

2 - 5 = PB PB1 PB2

6 -10 = PC PC1 PC2

11-14 = PD PD1 PD2

15-16 = PE PE1 PE2

97


Strategies for Oversight

Monitor RUG levels achieved and compare to national norms.

Number of days billed at each RUG level.

ADL END-SPLITS TRENDS

98



RUG Distribution

Polaris Group KIT data

2nd

Quarter 2015

1st

Quarter 2015

4th

Quarter 2014

3rd

Quarter 2014

RUG Group % % % %Ultra / Ext 1.24 1.17 1.10 1.00

Very High / Ext 0.56 0.56 0.41 0.44High / Ext 0.17 0.14 0.13 0.12

Medium / Ext 0.10 0.06 0.05 0.03Low / Ext 0.00 0.00 0.00 0.00Ultra High 57.47 55.92 57.76 57.62Very High 25.59 27.08 25.56 25.86

High 6.70 6.86 6.83 6.55Medium 2.77 2.76 2.71 2.78

Low 0.02 0.04 0.03 0.03


RUG Distribution

Polaris Group KIT data

2nd

Quarter 2015

1st

Quarter 2015

4th

Quarter 2014

3rd

Quarter 2014

RUG Group % % % %Extensive 3 0.17 0.18 0.16 0.21Extensive 2 0.16 0.10 0.09 0.11Extensive 1 0.18 0.14 0.13 0.12Special High 1.04 1.09 1.08 0.99Special Low 1.69 1.70 1.76 1.60

Special 0.00 0.00 0.00 0.00Complex 2 0.08 0.09 0.10 0.14Complex 1 1.16 1.18 1.16 1.29

Other 0.70 0.74 0.76 0.84




Monitor RUG levels achieved and compare to national norms.

Number of days billed at each RUG level.

ADL END-SPLITS TRENDS

101


Impact – Use Urban Rate Sheet

• Increase RUA to RUB times 100 days

– RUA x 100 days =

– RUB x 100 days =

– Increased revenue =

102



Impact – Use Urban Rate Sheet

• Increase RMB to RHB times 100 days

– RMB x 100 days =

– RHB x 100 days =

– Increased revenue =

103


STRATEGIES TO INCREASE LENGTH OF STAY

104



Impact of Increasing Length of Stay

• Increase in LOS by 2.0 days

• Average discharges per month = 4

• Average per diem $325 per day

105


• Financial Impact– 12 patient discharges

– X 2.0 increase in LOS

– X $325/day

$7,800/quarter

– $31,200/year

– $2,600/month

Impact of Increasing Length of Stay

106



Length of Stay Trends

Average LOS by Quarter

(Discharged Part A Patients Only)

* Source Polaris Group KIT Database

28.30 28.3328.98

27.9927.32

28.15

26.0026.5027.0027.5028.0028.5029.0029.50

1stQuarter

2014

2ndQuarter

2014

3rdQuarter

2014

4thQuarter

2014

1stQuarter

2015

2ndQuarter

2015


Discharges Within 30 Days

Discharges to Hospital

LOS 0-5

LOS6-10

LOS11-15

LOS 16-20

LOS 21-30

2nd Quarter 2015 26.37% 20.63% 16.05% 11.90% 14.82%

1st Quarter 2015 25.04% 20.41% 16.31% 11.82% 15.03%

Percent Discharged based on Length of Stay




Discharges Within 30 Days

Discharges by Day of Week

Discharges to Hospital Sun Mon Tue Wed Thu Fri Sat

2nd

Quarter 2015

10.84% 13.74% 13.06% 13.89% 13.93% 13.33% 10.99%

1st

Quarter 2015

10.06% 14.37% 13.85% 12.40% 13.50% 14.09% 10.36%



Return to Hospital

Percent of SNF discharges back to hospital

2nd

Quarter 2015

1st

Quarter 2015

4th

Quarter 2014

3rd

Quarter 2014

12.78% 12.76% 12.37% 13.01%




Length of Stay

• Nursing– Once therapy is discontinued, nursing should assess

for skillable nursing services

– EOT OMRA can now be measured

111


Length of Stay

• Therapy

– When does therapy start to treat

– When are patients discharged

• On Fridays

• All disciplines on the same day

• At the end of the month

112



Considerations for Length of Stay

Restorative Programming

• Establishing an individualized restorative program and training the caregivers must occur while the patient is in a skilled bed.

• Caregiver education as evidenced by return demonstration as well as the training/modification related to precautions has occurred.

• Implementing the restorative program prior to the discharge day will allow the patient to provide feedback regarding the program.

• Written restorative programs must be a part of the medical record to demonstrate the skilled intervention in creating and training the program.

113


Considerations for Managing LOS

Screening within 30 days

• When the patient is discharged to a long term care bed, re-screen the patient within 30 days to ensure the patient has maintained the functional level obtained while under Part A. If there has been a significant change, consult with the nursing for consideration of a transfer back into skilled care.

• When the patient is discharge to home or an ALF, establish a call back system to ensure the patient has retained the functional level since discharge. If there has been a significant change, consult with the physician/nursing for consideration of a readmission to skilled care.

114




Re-rugging to a lower level

• Consider re-rugging the patient into a medium or low category prior to discharge.

• Allows final few higher-level goals to be addressed

• Allows continued assessment of the functional level when therapy has lessened

• RL – 45 min over 7 days; therapy at least 3 days per week; any combination of PT, OT, ST; 2 or more restorative services

• RM – 150 min over 7 days; therapy 5 days per week; any combination of PT, OT, ST 115



Caregiver teaching and training

– Caregiver education is vital to the ongoing success of a patient’s achieved therapeutic outcome. Nursing and therapists demonstrate the ongoing skilled needs and specific precautions through comprehensive education throughout the skilled stay

– Documentation in the medical record of ongoing education is vital to the process

– Education may require multiple sessions to train and observe return demonstration by the patient/caregiver

116




Home Assessment:

• Can be conducted for patients receiving Medicare Part A and Part B services

• Requires a physician order for the home assessment

• May complete several weeks to several days prior to discharge

• The home assessment, significant findings, and goals should be clearly documented in the medical record along with specific activities and minutes spent conducting the home assessment

117



Other Considerations:

• Review residents who expire within 72 hours of admission to determine if admission was appropriate.

118



Unnecessary Hospital Transfers

• Increase focus by CMS related to hospital transfers with a LOS 30 days or less.

– If hospitals readmission rate is outside threshold CMS will take money back from hospital.

• Can impact relationships with hospitals and physician.

119


Unnecessary Hospital Transfers

• At a monthly or weekly risk management meeting, review all transfers to hospital to determine if they were avoidable.

• Perform ongoing audit and analysis. – Day of week

– Physician

– Care need issues

– Early or late intervention?

120



Evaluation of Transfers

– Once the evaluation is complete possible follow-up:

• If there were opportunities to prevent or anticipate the immediate reason for the transfer by earlier identification and management of a change in status then training should be provided to involved staff.

• If the resident could have been cared for here if the provider had been available or returned calls earlier work with the provider and the medical director to ensure more timely response to nursing home calls.

121


Evaluation of Transfers

– If the resident could have been cared for safely if the necessary tests or procedures (e.g. continuous IV) were available at the facility then review whether there are additional services could be instituted.

Staff training:Review preadmission and admission practicesHow to identify changes in status earlyHow to use early warning toolWhat to do if changes in status occurHow to communicate effectively with physicians

122




123



• Monitor number of EOT and COT during weekly meetings.

• Monitor RUG levels at routine meetings.

• Daily PPS management between MDSC and Therapy.

• Administrator – ask the tough questions

• Accurate MDS coding of ADLs

124




• Implement strategies to increase LOS. – Perform review hospital transfers to determine if

avoidable

– Identify trends

– Identify staff training needs

– Adjust culture

• Monitor RUG levels achieved and compare to national norms monthly. – Number of days billed at each RUG level

125


RUG-IV Quick ReferenceFY 2016

DevelopedbyPolarisGroup Page1

CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

ULTRA HIGH REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RUX

66

66 Rehabilitation Rx 720 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week; AND A second rehabilitation discipline 3 days/week 2-10 Not Used RUL 65 65

Or, Medicare Short Stay = Yes Average minutes 144 or more

AND Tracheostomy care, ventilator/respirator, or isolation for active infectious disease while a resident AND ADL score of 2 or more

VERY HIGH REHABILITATION PLUS EXTENSIVE SERVICES:

11-16 2-10

Not Used Not Used

RVX RVL

64 62

63 61

Rehabilitation Rx 500 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week

Or, Medicare Short Stay = Yes Average minutes 100 -143


HIGH REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RHX

61

62

Rehabilitation Rx 325 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week;

Or, Medicare Short Stay = Yes Average minutes 65 - 99 2-10 Not Used RHL 57 57


MEDIUM REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RMX

58

58

Rehabilitation Rx 150 minutes/week minimum AND a minimum of 5 distinct calendar days;

Or, Medicare Short Stay = Yes Average minutes 30 - 64 2-10 Not Used RML 55 55


LOW REHABILITATION PLUS EXTENSIVE SERVICES Rehabilitation Rx 45 minutes/week minimum

AND a minimum of 3 distinct calendar days; AND Restorative nursing 6 days/week, 2 services (see Reduced Physical Function (below) for restorative nursing services);

Or, Medicare Short Stay = Yes Average minutes 15 - 29


2-16

Not Used

RLX

52

53




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

ULTRA HIGH REHABILITATION 11-16

Not Used

RUC

60

60 Rehabilitation Rx 720 minutes/week minimum

AND 6-10 Not Used RUB 59 59At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RUA 54 51

AND A second rehabilitation discipline 3 days/week


VERY HIGH REHABILITATION 11-16

Not Used

RVC

53


6-10 Not Used RVB 49 47 AND At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RVA 48 46


HIGH REHABILITATION 11-16

Not Used

RHC

47


6-10 Not Used RHB 41 40 AND At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RHA 34 26


MEDIUM REHABILITATION 11-16 Not Used RMC 40 38 Rehabilitation Rx 150 minutes/week minimum 6-10 Not Used RMB 36 32

AND a minimum of 5 distinct calendar days; 0-5 Not Used RMA 19 18


LOW REHABILITATION Rehabilitation Rx 45 minutes/week minimum

AND a minimum of 3 distinct calendar days;

AND Restorative nursing 6 days/week, 2 services (see Physical Function for restorative nursing services)


11-16 0-10

Not Used Not Used

RLB RLA

37 8

37 7

EXTENSIVE SERVICES 2-16 Trach care & ES3 63 64 Tracheostomy care, ventilator/respirator, or isolation for active ventilator infectious disease while a resident /respirator

AND ADL score of 2 or more 2-16 Trach care or

ventilator ES2 56 56

/respirator

Isolation for

2-16 active infectious

ES1 51 52

disease




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

SPECIAL CARE HIGH Comatose; septicemia; diabetes with daily injections and order change on 2 or more days; quadriplegia with ADL score >=5; chronic obstructive pulmonary disease and shortness of breath when lying flat; fever with pneumonia, or vomiting, or tube feeding (received in the entire last 7 days: calories >= 51% or calories = 26-50% and fluid >= 501cc), or weight loss; parenteral/IV feedings (both while a resident or while not a resident); respiratory therapy for 7 days

AND ADL score of 2 or more

Signs of Depression PHQ Score >=9.5

15-16 15-16

11-14 11-14

6-10 6-10

2-5 2-5

Depression Not Depressed

Depression

Not Depressed


Depression

Not Depressed

HE2

HE1

HD2 HD1

HC2 HC1

HB2 HB1

50

39

46

35

44 28

43 27

50

41

49

36

44 29

43 28

SPECIAL CARE LOW Cerebral palsy, multiple sclerosis, or Parkinson’s disease with ADL score >=5; respiratory failure and oxygen while a resident; feeding tube (received in the entire last 7 days - calories >= 51% or calories = 26- 50% and fluid >= 501cc); ulcers (2 or more stage II or one or more or stage III or IV pressure ulcers; or 2 or more venous/arterial ulcers; or one stage II pressure ulcer and one venous/arterial ulcer) with 2 or more skin care treatments; foot infection/diabetic foot ulcer/open lesions of foot with treatment; radiation therapy while a resident; dialysis while a resident

AND ADL score of 2 or more Signs Depression PHQ Score >=9.5

15-16 15-16

11-14 11-14

6-10

6-10

2-5

2-5


Depression

Not Depressed

Depression

Not Depressed

Depression

Not Depressed

LE2 LE1

LD2 LD1

LC2 LC1

LB2

LB1

45 31

42 26

33 18

25

15

45 33

42 27

35 19

25

15

CLINICALLY COMPLEX 15-16 Depression CE2 38 39 Extensive Services, Special Care High or Special Care Low qualifier and 15-16 Not Depressed CE1 30 31ADL score of 0 or 1 OR

Pneumonia; hemiplegia with ADL score >=5; surgical wounds or open lesions with treatment; burns; chemotherapy while a resident; IV

11-14 11-14


CD2 CD1

32 23

34 23

medications while a resident; oxygen therapy while a resident; transfusions while a resident 6-10

6-10 Depression

Not Depressed CC2 CC1

21 17

21 17

2-5 Depression CB2 16 16

Signs of Depression PHQ Score >=9.5 2-5 Not Depressed CB1 13 13

0-1 Depression CA2 9 9 0-1 Not Depressed CA1 6 6




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

BEHAVIORAL SYMPTOMS and COGNITIVE PERFORMANCE 2-5 2+ RNS 6+ BB2 11 11 Cognitive impairment BIMS score <=9 or CPS >=3 days/wk OR hallucinations or delusions

OR physical or verbal behavioral symptoms toward others, other behavioral 2-5 Less RNS BB1 10 10

symptoms, rejection of care, or wandering exited 4 or more days0-1 2+ RNS 6+ BA2 4 4

AND ADL score <=5 0-1

days/wk

Less RNS

BA1

3

3

REDUCED PHYSICAL FUNCTION 15-16 2+ RNS 6+ PE2 29 30 Restorative nursing services: days/wk

Urinary and/or bowel training program passive and/or active ROM

15-16 Less RNS PE1 24 24

amputation/prosthesis care training splint or brace assistance dressing or grooming training eating or swallowing training

11-14

11-14

2+ RNS 6+ days/wk

Less RNS

PD2

PD1

22

20

22

20

transfer training bed mobility and/or walking training communication training

6-10 2+ RNS 6+ days/wk

PC2 14 14

NOTES: No clinical variables used

6-10 Less RNS PC1 12 12


PB2

7

8

2-5 Less RNS PB1 5 50-1 2+ RNS 6+

days/wk PA2 2 2

0-1 Less RNS PA1 1 1

DEFAULT AAA




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

ULTRA HIGH REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RUX

66

66 Rehabilitation Rx 720 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week; AND A second rehabilitation discipline 3 days/week 2-10 Not Used RUL 65 65



VERY HIGH REHABILITATION PLUS EXTENSIVE SERVICES:

11-16 2-10

Not Used Not Used

RVX RVL

64 62

63 61

Rehabilitation Rx 500 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week



HIGH REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RHX

61

62

Rehabilitation Rx 325 minutes/week minimum AND At least 1 rehabilitation discipline 5 days/week;

Or, Medicare Short Stay = Yes Average minutes 65 - 99 2-10 Not Used RHL 57 57


MEDIUM REHABILITATION PLUS EXTENSIVE SERVICES

11-16

Not Used

RMX

58

58

Rehabilitation Rx 150 minutes/week minimum AND a minimum of 5 distinct calendar days;

Or, Medicare Short Stay = Yes Average minutes 30 - 64 2-10 Not Used RML 55 55


LOW REHABILITATION PLUS EXTENSIVE SERVICES Rehabilitation Rx 45 minutes/week minimum

AND a minimum of 3 distinct calendar days; AND Restorative nursing 6 days/week, 2 services (see Reduced Physical Function (below) for restorative nursing services);



2-16

Not Used

RLX

52

53




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

ULTRA HIGH REHABILITATION 11-16

Not Used

RUC

60


AND 6-10 Not Used RUB 59 59At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RUA 54 51

AND A second rehabilitation discipline 3 days/week


VERY HIGH REHABILITATION 11-16

Not Used

RVC

53


6-10 Not Used RVB 49 47 AND At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RVA 48 46


HIGH REHABILITATION 11-16

Not Used

RHC

47


6-10 Not Used RHB 41 40 AND At least 1 rehabilitation discipline 5 days/week 0-5 Not Used RHA 34 26


MEDIUM REHABILITATION 11-16 Not Used RMC 40 38 Rehabilitation Rx 150 minutes/week minimum 6-10 Not Used RMB 36 32

AND a minimum of 5 distinct calendar days; 0-5 Not Used RMA 19 18


LOW REHABILITATION Rehabilitation Rx 45 minutes/week minimum

AND a minimum of 3 distinct calendar days;

AND Restorative nursing 6 days/week, 2 services (see Physical Function for restorative nursing services)


11-16 0-10

Not Used Not Used

RLB RLA

37 8

37 7

EXTENSIVE SERVICES 2-16 Trach care & ES3 63 64 Tracheostomy care, ventilator/respirator, or isolation for active ventilator infectious disease while a resident /respirator

AND ADL score of 2 or more 2-16 Trach care or

ventilator ES2 56 56

/respirator

Isolation for

2-16 active infectious

ES1 51 52

disease




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

SPECIAL CARE HIGH Comatose; septicemia; diabetes with daily injections and order change on 2 or more days; quadriplegia with ADL score >=5; chronic obstructive pulmonary disease and shortness of breath when lying flat; fever with pneumonia, or vomiting, or tube feeding (received in the entire last 7 days: calories >= 51% or calories = 26-50% and fluid >= 501cc), or weight loss; parenteral/IV feedings (both while a resident or while not a resident); respiratory therapy for 7 days

AND ADL score of 2 or more

Signs of Depression PHQ Score >=9.5

15-16 15-16

11-14 11-14

6-10 6-10

2-5 2-5


Depression

Not Depressed


Depression

Not Depressed

HE2

HE1

HD2 HD1

HC2 HC1

HB2 HB1

50

39

46

35

44 28

43 27

50

41

49

36

44 29

43 28

SPECIAL CARE LOW Cerebral palsy, multiple sclerosis, or Parkinson’s disease with ADL score >=5; respiratory failure and oxygen while a resident; feeding tube (received in the entire last 7 days - calories >= 51% or calories = 26- 50% and fluid >= 501cc); ulcers (2 or more stage II or one or more or stage III or IV pressure ulcers; or 2 or more venous/arterial ulcers; or one stage II pressure ulcer and one venous/arterial ulcer) with 2 or more skin care treatments; foot infection/diabetic foot ulcer/open lesions of foot with treatment; radiation therapy while a resident; dialysis while a resident

AND ADL score of 2 or more Signs Depression PHQ Score >=9.5

15-16 15-16

11-14 11-14

6-10

6-10

2-5

2-5


Depression

Not Depressed

Depression

Not Depressed

Depression

Not Depressed

LE2 LE1

LD2 LD1

LC2 LC1

LB2

LB1

45 31

42 26

33 18

25

15

45 33

42 27

35 19

25

15

CLINICALLY COMPLEX 15-16 Depression CE2 38 39 Extensive Services, Special Care High or Special Care Low qualifier and 15-16 Not Depressed CE1 30 31ADL score of 0 or 1 OR

Pneumonia; hemiplegia with ADL score >=5; surgical wounds or open lesions with treatment; burns; chemotherapy while a resident; IV

11-14 11-14


CD2 CD1

32 23

34 23

medications while a resident; oxygen therapy while a resident; transfusions while a resident 6-10

6-10 Depression

Not Depressed CC2 CC1

21 17

21 17

2-5 Depression CB2 16 16

Signs of Depression PHQ Score >=9.5 2-5 Not Depressed CB1 13 13

0-1 Depression CA2 9 9 0-1 Not Depressed CA1 6 6




CATEGORY

ADL

INDEX

END SPLITS MDS

RUG-IV CODES

CMI

Rural

CMI

Urban

BEHAVIORAL SYMPTOMS and COGNITIVE PERFORMANCE 2-5 2+ RNS 6+ BB2 11 11 Cognitive impairment BIMS score <=9 or CPS >=3 days/wk OR hallucinations or delusions

OR physical or verbal behavioral symptoms toward others, other behavioral 2-5 Less RNS BB1 10 10

symptoms, rejection of care, or wandering exited 4 or more days0-1 2+ RNS 6+ BA2 4 4

AND ADL score <=5 0-1

days/wk

Less RNS

BA1

3

3

REDUCED PHYSICAL FUNCTION 15-16 2+ RNS 6+ PE2 29 30 Restorative nursing services: days/wk

Urinary and/or bowel training program passive and/or active ROM

15-16 Less RNS PE1 24 24

amputation/prosthesis care training splint or brace assistance dressing or grooming training eating or swallowing training

11-14

11-14

2+ RNS 6+ days/wk

Less RNS

PD2

PD1

22

20

22

20

transfer training bed mobility and/or walking training communication training


PC2 14 14

NOTES: No clinical variables used

6-10 Less RNS PC1 12 12


PB2

7

8

2-5 Less RNS PB1 5 50-1 2+ RNS 6+

days/wk PA2 2 2

0-1 Less RNS PA1 1 1

DEFAULT AAA


CPS SCORING RULES Impairment Count

(Number of the following): • Decision Making: Not Independent = 1-2 • Understood: Not Independent = 1-3 • Short-Term Memory: Not OK = 1

Severe Impairment Count (Number of the following):

• Decision Making: Mod: Impaired = 2 • Understood: Sometimes/Never = 2-3

All Residents

Coma?

Decision-Making

Impairment Count?

Total Dependent

Eating?

Yes (1) No (0, -)

No (0-3, -)

Yes (4, 8)

Severely Impaired (3) Not Severely Impaired

(0-2, -)

0 2 or 3

1 Severe

Impairment Count?

0 2

1

Intact

24.9

Borderline Intact 24.9

Mild Impairment

19.2

Moderate Impairment

15.4

Mod. Severe Impairment

6.9

Severe Impairment

5.1

Very Severe Impairment

0.4

(0) (1) (2) (3) (4) (5) (6)

Average mini mental score in field trial where 30 is best and 0 is

worst

NOTE: Values are denoted as (0-2,-); dash signifies missing data. The CPS scale is used in the RUG-IV classification system to measure a resident’s cognitive performance. The RUG-IV Classification system uses the CPS scale to identify residents who demonstrate moderate to severe cognitive impairment as a basis for classification in Impaired Cognition RUG-IV groups.


RUG-IV

Category

Nursing

Index

Therapy

Index

Nursing

Component

Therapy

Component

Non-case Mix

Therapy Comp

Non-case Mix

ComponentTotal Rate CMI

RUX 2.67 1.87 $457.02 $241.12 $86.36 $785.50 66

RUL 2.57 1.87 $439.91 $241.12 $86.36 $768.39 65

ES3 3.58 $612.79 $16.98 $86.36 $717.13 64

RVX 2.61 1.28 $446.75 $165.04 $86.36 $699.15 63

RHX 2.55 0.85 $436.48 $109.60 $86.36 $633.44 62

RVL 2.19 1.28 $374.86 $165.04 $86.36 $627.26 61

RUC 1.56 1.87 $267.03 $241.12 $86.36 $595.51 60

RUB 1.56 1.87 $267.03 $241.12 $86.36 $595.51 59

RMX 2.47 0.55 $422.79 $70.92 $86.36 $581.07 58

RHL 2.15 0.85 $368.02 $109.60 $86.36 $564.98 57

ES2 2.67 $457.02 $16.98 $86.36 $561.36 56

RML 2.19 0.55 $374.86 $70.92 $86.36 $533.14 55

RVC 1.51 1.28 $258.47 $165.04 $86.36 $510.87 54

RLX 2.26 0.28 $386.84 $36.10 $86.36 $510.30 53

ES1 2.32 $397.11 $16.98 $86.36 $501.45 52

RUA 0.99 1.87 $169.46 $241.12 $86.36 $497.94 51

HE2 2.22 $380.00 $16.98 $86.36 $484.34 50

HD2 2.04 $349.19 $16.98 $86.36 $453.53 49

RHC 1.45 0.85 $248.20 $109.60 $86.36 $445.16 48

RVB 1.11 1.28 $190.00 $165.04 $86.36 $442.40 47

RVA 1.10 1.28 $188.29 $165.04 $86.36 $440.69 46

LE2 1.96 $335.49 $16.98 $86.36 $439.83 45

HC2 1.89 $323.51 $16.98 $86.36 $427.85 44

HB2 1.86 $318.38 $16.98 $86.36 $422.72 43

LD2 1.86 $318.38 $16.98 $86.36 $422.72 42

HE1 1.74 $297.84 $16.98 $86.36 $402.18 41

RHB 1.19 0.85 $203.69 $109.60 $86.36 $400.65 40

CE2 1.68 $287.57 $16.98 $86.36 $391.91 39

RMC 1.36 0.55 $232.79 $70.92 $86.36 $391.07 38

RLB 1.50 0.28 $256.76 $36.10 $86.36 $380.22 37

HD1 1.60 $273.87 $16.98 $86.36 $378.21 36

LC2 1.56 $267.03 $16.98 $86.36 $371.37 35

CD2 1.56 $267.03 $16.98 $86.36 $371.37 34

LE1 1.54 $263.60 $16.98 $86.36 $367.94 33

RMB 1.22 0.55 $208.83 $70.92 $86.36 $367.11 32

CE1 1.50 $256.76 $16.98 $86.36 $361.10 31

PE2 1.50 $256.76 $16.98 $86.36 $361.10 30

HC1 1.48 $253.33 $16.98 $86.36 $357.67 29

HB1 1.46 $249.91 $16.98 $86.36 $354.25 28

LD1 1.46 $249.91 $16.98 $86.36 $354.25 27

RHA 0.91 0.85 $155.76 $109.60 $86.36 $352.72 26

LB2 1.45 $248.20 $16.98 $86.36 $352.54 25

RUG-IV URBAN FY 2016 (Eff. Oct 1, 2015)

Case-Mix Adjusted Federal Rates and Associated Indexes

Maximizing


PE1 1.40 $239.64 $16.98 $86.36 $343.98 24

CD1 1.38 $236.21 $16.98 $86.36 $340.55 23

PD2 1.38 $236.21 $16.98 $86.36 $340.55 22

CC2 1.29 $220.81 $16.98 $86.36 $325.15 21

PD1 1.28 $219.10 $16.98 $86.36 $323.44 20

LC1 1.22 $208.83 $16.98 $86.36 $313.17 19

RMA 0.84 0.55 $143.78 $70.92 $86.36 $302.06 18

CC1 1.15 $196.85 $16.98 $86.36 $301.19 17

CB2 1.15 $196.85 $16.98 $86.36 $301.19 16

LB1 1.14 $195.13 $16.98 $86.36 $299.47 15

PC2 1.10 $188.29 $16.98 $86.36 $292.63 14

CB1 1.02 $174.59 $16.98 $86.36 $278.93 13

PC1 1.02 $174.59 $16.98 $86.36 $278.93 12

BB2 0.97 $166.03 $16.98 $86.36 $270.37 11

BB1 0.90 $154.05 $16.98 $86.36 $258.39 10

CA2 0.88 $150.63 $16.98 $86.36 $254.97 9

PB2 0.84 $143.78 $16.98 $86.36 $248.12 8

RLA 0.71 0.28 $121.53 $36.10 $86.36 $244.99 7

CA1 0.78 $133.51 $16.98 $86.36 $237.85 6

PB1 0.78 $133.51 $16.98 $86.36 $237.85 5

BA2 0.70 $119.82 $16.98 $86.36 $224.16 4

BA1 0.64 $109.55 $16.98 $86.36 $213.89 3

PA2 0.59 $100.99 $16.98 $86.36 $205.33 2

PA1 0.54 $92.43 $16.98 $86.36 $196.77 1


RUG-IVCategory

Nursing Index

Therapy Index

Nursing Component

Therapy Component


Non-case Mix Component Total Rate CMI

RUX 2.67 1.87 $451.98 $238.44 $86.39 $776.81 66RUL 2.57 1.87 $435.05 $238.44 $86.39 $759.88 65ES3 3.58 $606.02 $16.79 $86.39 $709.20 64RVX 2.61 1.28 $441.82 $163.21 $86.39 $691.42 63RHX 2.55 0.85 $431.66 $108.38 $86.39 $626.43 62RVL 2.19 1.28 $370.72 $163.21 $86.39 $620.32 61RUC 1.56 1.87 $264.08 $238.44 $86.39 $588.91 60RUB 1.56 1.87 $264.08 $238.44 $86.39 $588.91 59RMX 2.47 0.55 $418.12 $70.13 $86.39 $574.64 58RHL 2.15 0.85 $363.95 $108.38 $86.39 $558.72 57ES2 2.67 $451.98 $16.79 $86.39 $555.16 56RML 2.19 0.55 $370.72 $70.13 $86.39 $527.24 55RVC 1.51 1.28 $255.61 $163.21 $86.39 $505.21 54RLX 2.26 0.28 $382.57 $35.70 $86.39 $504.66 53ES1 2.32 $392.73 $16.79 $86.39 $495.91 52RUA 0.99 1.87 $167.59 $238.44 $86.39 $492.42 51HE2 2.22 $375.80 $16.79 $86.39 $478.98 50HD2 2.04 $345.33 $16.79 $86.39 $448.51 49RHC 1.45 0.85 $245.46 $108.38 $86.39 $440.23 48RVB 1.11 1.28 $187.90 $163.21 $86.39 $437.50 47RVA 1.10 1.28 $186.21 $163.21 $86.39 $435.81 46LE2 1.96 $331.79 $16.79 $86.39 $434.97 45HC2 1.89 $319.94 $16.79 $86.39 $423.12 44HB2 1.86 $314.86 $16.79 $86.39 $418.04 43LD2 1.86 $314.86 $16.79 $86.39 $418.04 42HE1 1.74 $294.55 $16.79 $86.39 $397.73 41RHB 1.19 0.85 $201.44 $108.38 $86.39 $396.21 40CE2 1.68 $284.39 $16.79 $86.39 $387.57 39RMC 1.36 0.55 $230.22 $70.13 $86.39 $386.74 38RLB 1.50 0.28 $253.92 $35.70 $86.39 $376.01 37HD1 1.60 $270.85 $16.79 $86.39 $374.03 36LC2 1.56 $264.08 $16.79 $86.39 $367.26 35CD2 1.56 $264.08 $16.79 $86.39 $367.26 34LE1 1.54 $260.69 $16.79 $86.39 $363.87 33RMB 1.22 0.55 $206.52 $70.13 $86.39 $363.04 32CE1 1.50 $253.92 $16.79 $86.39 $357.10 31PE2 1.50 $253.92 $16.79 $86.39 $357.10 30HC1 1.48 $250.53 $16.79 $86.39 $353.71 29HB1 1.46 $247.15 $16.79 $86.39 $350.33 28LD1 1.46 $247.15 $16.79 $86.39 $350.33 27RHA 0.91 0.85 $154.04 $108.38 $86.39 $348.81 26LB2 1.45 $245.46 $16.79 $86.39 $348.64 25

Maximizing RUG-IV URBAN FY 2015 (Eff. Oct 1, 2014) Case-Mix Adjusted Federal Rates and Associated Indexes


PE1 1.40 $236.99 $16.79 $86.39 $340.17 24CD1 1.38 $233.61 $16.79 $86.39 $336.79 23PD2 1.38 $233.61 $16.79 $86.39 $336.79 22CC2 1.29 $218.37 $16.79 $86.39 $321.55 21PD1 1.28 $216.68 $16.79 $86.39 $319.86 20LC1 1.22 $206.52 $16.79 $86.39 $309.70 19RMA 0.84 0.55 $142.20 $70.13 $86.39 $298.72 18CC1 1.15 $194.67 $16.79 $86.39 $297.85 17CB2 1.15 $194.67 $16.79 $86.39 $297.85 16LB1 1.14 $192.98 $16.79 $86.39 $296.16 15PC2 1.10 $186.21 $16.79 $86.39 $289.39 14CB1 1.02 $172.67 $16.79 $86.39 $275.85 13PC1 1.02 $172.67 $16.79 $86.39 $275.85 12BB2 0.97 $164.20 $16.79 $86.39 $267.38 11BB1 0.90 $152.35 $16.79 $86.39 $255.53 10CA2 0.88 $148.97 $16.79 $86.39 $252.15 9PB2 0.84 $142.20 $16.79 $86.39 $245.38 8RLA 0.71 0.28 $120.19 $35.70 $86.39 $242.28 7CA1 0.78 $132.04 $16.79 $86.39 $235.22 6PB1 0.78 $132.04 $16.79 $86.39 $235.22 5BA2 0.70 $118.50 $16.79 $86.39 $221.68 4BA1 0.64 $108.34 $16.79 $86.39 $211.52 3PA2 0.59 $99.88 $16.79 $86.39 $203.06 2PA1 0.54 $91.41 $16.79 $86.39 $194.59 1


RUG-IVCategory

Nursing Index

Therapy Index

Nursing Component

Therapy Component



RUX 2.67 1.87 $436.63 $278.01 $88.97 $803.61 66RUL 2.57 1.87 $420.27 $278.01 $88.97 $787.25 65RVX 2.61 1.28 $426.81 $190.30 $88.97 $706.08 64ES3 3.58 $585.44 $18.14 $88.97 $692.55 63RVL 2.19 1.28 $358.13 $190.30 $88.97 $637.40 62RHX 2.55 0.85 $417.00 $126.37 $88.97 $632.34 61RUC 1.56 1.87 $255.11 $278.01 $88.97 $622.09 60RUB 1.56 1.87 $255.11 $278.01 $88.97 $622.09 59RMX 2.47 0.55 $403.92 $81.77 $88.97 $574.66 58RHL 2.15 0.85 $351.59 $126.37 $88.97 $566.93 57ES2 2.67 $436.63 $18.14 $88.97 $543.74 56RML 2.19 0.55 $358.13 $81.77 $88.97 $528.87 55RUA 0.99 1.87 $161.89 $278.01 $88.97 $528.87 54RVC 1.51 1.28 $246.93 $190.30 $88.97 $526.20 53RLX 2.26 0.28 $369.58 $41.63 $88.97 $500.18 52ES1 2.32 $379.39 $18.14 $88.97 $486.50 51HE2 2.22 $363.04 $18.14 $88.97 $470.15 50RVB 1.11 1.28 $181.52 $190.30 $88.97 $460.79 49RVA 1.10 1.28 $179.88 $190.30 $88.97 $459.15 48RHC 1.45 0.85 $237.12 $126.37 $88.97 $452.46 47HD2 2.04 $333.60 $18.14 $88.97 $440.71 46LE2 1.96 $320.52 $18.14 $88.97 $427.63 45HC2 1.89 $309.07 $18.14 $88.97 $416.18 44HB2 1.86 $304.17 $18.14 $88.97 $411.28 43LD2 1.86 $304.17 $18.14 $88.97 $411.28 42RHB 1.19 0.85 $194.60 $126.37 $88.97 $409.94 41RMC 1.36 0.55 $222.40 $81.77 $88.97 $393.14 40HE1 1.74 $284.54 $18.14 $88.97 $391.65 39CE2 1.68 $274.73 $18.14 $88.97 $381.84 38RLB 1.50 0.28 $245.30 $41.63 $88.97 $375.90 37RMB 1.22 0.55 $199.51 $81.77 $88.97 $370.25 36HD1 1.60 $261.65 $18.14 $88.97 $368.76 35RHA 0.91 0.85 $148.81 $126.37 $88.97 $364.15 34LC2 1.56 $255.11 $18.14 $88.97 $362.22 33CD2 1.56 $255.11 $18.14 $88.97 $362.22 32LE1 1.54 $251.84 $18.14 $88.97 $358.95 31CE1 1.50 $245.30 $18.14 $88.97 $352.41 30PE2 1.50 $245.30 $18.14 $88.97 $352.41 29HC1 1.48 $242.02 $18.14 $88.97 $349.13 28HB1 1.46 $238.75 $18.14 $88.97 $345.86 27LD1 1.46 $238.75 $18.14 $88.97 $345.86 26

RUG-IV RURAL FY 2016 (Eff. Oct 1, 2015) Case-Mix Adjusted Federal Rates and Associated Indexes

Maximizing


LB2 1.45 $237.12 $18.14 $88.97 $344.23 25PE1 1.40 $228.94 $18.14 $88.97 $336.05 24CD1 1.38 $225.67 $18.14 $88.97 $332.78 23PD2 1.38 $225.67 $18.14 $88.97 $332.78 22CC2 1.29 $210.05 $18.14 $88.97 $318.06 21PD1 1.28 $209.32 $18.14 $88.97 $316.43 20RMA 0.84 0.55 $137.37 $81.77 $88.97 $308.11 19LC1 1.22 $199.51 $18.14 $88.97 $306.62 18CC1 1.15 $188.06 $18.14 $88.97 $295.17 17CB2 1.15 $188.06 $18.14 $88.97 $295.17 16LB1 1.14 $186.42 $18.14 $88.97 $293.53 15PC2 1.10 $179.88 $18.14 $88.97 $286.99 14CB1 1.02 $166.80 $18.14 $88.97 $273.91 13PC1 1.02 $166.80 $18.14 $88.97 $273.91 12BB2 0.97 $158.62 $18.14 $88.97 $265.73 11BB1 0.90 $147.18 $18.14 $88.97 $254.29 10CA2 0.88 $143.91 $18.14 $88.97 $251.02 9RLA 0.71 0.28 $116.11 $41.63 $88.97 $246.71 8PB2 0.84 $137.37 $18.14 $88.97 $244.48 7CA1 0.78 $127.55 $18.14 $88.97 $234.66 6PB1 0.78 $127.55 $18.14 $88.97 $234.66 5BA2 0.70 $114.47 $18.14 $88.97 $221.58 4BA1 0.64 $104.66 $18.14 $88.97 $211.77 3PA2 0.59 $96.48 $18.14 $88.97 $203.59 2PA1 0.54 $88.31 $18.14 $88.97 $195.42 1


RUG-IVCategory

Nursing Index

Therapy Index

Nursing Component

Therapy Component



RUX 2.67 1.87 $431.79 $274.93 $87.99 $794.71 66RUL 2.57 1.87 $415.62 $274.93 $87.99 $778.54 65RVX 2.61 1.28 $422.09 $188.19 $87.99 $698.27 64ES3 3.58 $578.96 $17.94 $87.99 $684.89 63RVL 2.19 1.28 $354.17 $188.19 $87.99 $630.35 62RHX 2.55 0.85 $412.39 $124.97 $87.99 $625.35 61RUC 1.56 1.87 $252.28 $274.93 $87.99 $615.20 60RUB 1.56 1.87 $252.28 $274.93 $87.99 $615.20 59RMX 2.47 0.55 $399.45 $80.86 $87.99 $568.30 58RHL 2.15 0.85 $347.70 $124.97 $87.99 $560.66 57ES2 2.67 $431.79 $17.94 $87.99 $537.72 56RML 2.19 0.55 $354.17 $80.86 $87.99 $523.02 55RUA 0.99 1.87 $160.10 $274.93 $87.99 $523.02 54RVC 1.51 1.28 $244.20 $188.19 $87.99 $520.38 53RLX 2.26 0.28 $365.49 $41.17 $87.99 $494.65 52ES1 2.32 $375.19 $17.94 $87.99 $481.12 51HE2 2.22 $359.02 $17.94 $87.99 $464.95 50RVB 1.11 1.28 $179.51 $188.19 $87.99 $455.69 49RVA 1.10 1.28 $177.89 $188.19 $87.99 $454.07 48RHC 1.45 0.85 $234.49 $124.97 $87.99 $447.45 47HD2 2.04 $329.91 $17.94 $87.99 $435.84 46LE2 1.96 $316.97 $17.94 $87.99 $422.90 45HC2 1.89 $305.65 $17.94 $87.99 $411.58 44HB2 1.86 $300.80 $17.94 $87.99 $406.73 43LD2 1.86 $300.80 $17.94 $87.99 $406.73 42RHB 1.19 0.85 $192.45 $124.97 $87.99 $405.41 41RMC 1.36 0.55 $219.94 $80.86 $87.99 $388.79 40HE1 1.74 $281.39 $17.94 $87.99 $387.32 39CE2 1.68 $271.69 $17.94 $87.99 $377.62 38RLB 1.50 0.28 $242.58 $41.17 $87.99 $371.74 37RMB 1.22 0.55 $197.30 $80.86 $87.99 $366.15 36HD1 1.60 $258.75 $17.94 $87.99 $364.68 35RHA 0.91 0.85 $147.17 $124.97 $87.99 $360.13 34LC2 1.56 $252.28 $17.94 $87.99 $358.21 33CD2 1.56 $252.28 $17.94 $87.99 $358.21 32LE1 1.54 $249.05 $17.94 $87.99 $354.98 31CE1 1.50 $242.58 $17.94 $87.99 $348.51 30PE2 1.50 $242.58 $17.94 $87.99 $348.51 29HC1 1.48 $239.35 $17.94 $87.99 $345.28 28HB1 1.46 $236.11 $17.94 $87.99 $342.04 27LD1 1.46 $236.11 $17.94 $87.99 $342.04 26

Maximizing RUG-IV RURAL FY 2015 (Eff. Oct 1, 2014) Case-Mix Adjusted Federal Rates and Associated Indexes


LB2 1.45 $234.49 $17.94 $87.99 $340.42 25PE1 1.40 $226.41 $17.94 $87.99 $332.34 24CD1 1.38 $223.17 $17.94 $87.99 $329.10 23PD2 1.38 $223.17 $17.94 $87.99 $329.10 22CC2 1.29 $208.62 $17.94 $87.99 $314.55 21PD1 1.28 $207.00 $17.94 $87.99 $312.93 20RMA 0.84 0.55 $135.84 $80.86 $87.99 $304.69 19LC1 1.22 $197.30 $17.94 $87.99 $303.23 18CC1 1.15 $185.98 $17.94 $87.99 $291.91 17CB2 1.15 $185.98 $17.94 $87.99 $291.91 16LB1 1.14 $184.36 $17.94 $87.99 $290.29 15PC2 1.10 $177.89 $17.94 $87.99 $283.82 14CB1 1.02 $164.95 $17.94 $87.99 $270.88 13PC1 1.02 $164.95 $17.94 $87.99 $270.88 12BB2 0.97 $156.87 $17.94 $87.99 $262.80 11BB1 0.90 $145.55 $17.94 $87.99 $251.48 10CA2 0.88 $142.31 $17.94 $87.99 $248.24 9RLA 0.71 0.28 $114.82 $41.17 $87.99 $243.98 8PB2 0.84 $135.84 $17.94 $87.99 $241.77 7CA1 0.78 $126.14 $17.94 $87.99 $232.07 6PB1 0.78 $126.14 $17.94 $87.99 $232.07 5BA2 0.70 $113.20 $17.94 $87.99 $219.13 4BA1 0.64 $103.50 $17.94 $87.99 $209.43 3PA2 0.59 $95.41 $17.94 $87.99 $201.34 2PA1 0.54 $87.33 $17.94 $87.99 $193.26 1


RUG IV ADL Index Score

Total Scores For: Bed Mobility + Transfer + Eating + Toilet Use = ADL INDEX SCORE

To calculate the ADL score use the following chart for bed mobility (G0110A), transfer (G0110B), and toilet use (G0110I). Enter the ADL score for each item.

(A) Self-Performance is:

(B) Support is:

G0110A 1&2 G0110B 1&2 G0110I 1&2 Bed Mobility Transfer Toilet Use

0 = Independent OR

1 = supervision OR

7 = Activity only occurred once or twice OR

8 = Activity did not occur OR

- Not assessed

Any Number 0 0 0

2 = Limited Assist Any Number 1 1 1

3 = Extensive Assist

0 = No set-up OR

1 = Set-up only OR

2 = One person OR

- Not assessed

2 2 2

4 = Total Dependence

0 = No set-up OR

1 = Set-up only OR

2 = One person OR

- Not assessed

3 3 3

3 = Extensive Assist OR

4 = Total Dependence 3 = Two person 4 4 4

Total Index Score for Bed Mobility + Transfers + Toileting


(B) Support is:

G0110H 1&2 Eating

--, 0, 1, 2, 7, 8 --, 0, 1, 8 0

--, 0, 1, 2, 7, 8 2 or 3 2

3 or 4 --, 0, 1 2

3 2 or 3 3

4 2 or 3 4

Eating Index Score

TOTAL ADL SCORE

Add both Index Scores for a Total ADL Score:


CASE STUDY #1 RUG-IV ADL INDEX SCORE Bed Mobility, Transfer and Toilet Use: Self-performance =3 Support =2 Eating: Self-performance = 1 Support= 1 Response in Section G for column: Circle the ADL points that meet the criteria


(B) Support is:

G0110-1A1&2 G0100-1B1&2 G0100-1I1&2 Bed Mobility Transfer Toilet Use

0 = Independent OR 1 = Supervision OR 7 = Activity only 1/2x2 OR 8 = Did not occur OR -- = Not assessed

Any Number OR

-- = Not assessed 0 0 0

2 = Limited Assist Any code

OR -- = Not assessed

1 1 1


0 = No set-up OR

1 = Set-up only OR

2 = One person OR

-- = Not assessed

2 2 2

4 = Total Depend

0 = No set-up OR

1 = Set-up only OR

2 = One person OR

-- = Not assessed

3 3 3

3 = Extensive Assist OR 4 = Total Depend

3 = Two person 4 4 4

The Index Score is the total of all circled points which met criteria for each ADL.


(B) Support is:

G0116-1H1&2 Eating

--, 0, 1, 2, 7, 8 --, 0, 1, 8 0 --, 0, 1, 2, 7, 8 2 or 3 2

3 or 4 --, 0, 1 2 3 2 or 3 3 4 2 or 3 4

The Eating Index Score is the above circled point value which met criteria TOTAL ADL SCORE- Add both Index Scores for a Total ADL Score:


CASE STUDY #2 RUG-IV ADL INDEX SCORE Bed Mobility Self-Performance=3 Support=2; Transfer Self-performance=4 Support=3; Toilet Use: Self-performance =4 Support =3; Eating: Self-performance = 2 Support= 2

Response in Section G for column: Circle the ADL points that meet the criteria


(B) Support is:

G0110-1A1&2 G0100-1B1&2 G0100-1I1&2 Bed Mobility Transfer Toilet Use

0 = Independent OR 1 = Supervision OR 7 = Activity only 1/2x2 OR 8 = Did not occur OR -- = Not assessed

Any Number OR

-- = Not assessed 0 0 0

2 = Limited Assist Any code

OR -- = Not assessed

1 1 1


0 = No set-up OR

1 = Set-up only OR

2 = One person OR

-- = Not assessed

2 2 2

4 = Total Depend

0 = No set-up OR

1 = Set-up only OR

2 = One person OR

-- = Not assessed

3 3 3

3 = Extensive Assist OR 4 = Total Depend

3 = Two person 4 4 4

The Index Score is the total of all circled points which met criteria for each ADL. (A)

Self-Performance is: (B)

Support is: G0116-1H1&2

Eating --, 0, 1, 2, 7, 8 --, 0, 1, 8 0 --, 0, 1, 2, 7, 8 2 or 3 2

3 or 4 --, 0, 1 2 3 2 or 3 3 4 2 or 3 4

The Eating Index Score is the above circled point value which met criteria TOTAL ADL SCORE - Add both Index Scores for a Total ADL Score:


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