SNF PPS: RUG-IV Categories and Characteristics 1 Major RUG-IV Category RUG-IV Score Characteristics Associated With Major RUG-IV Category Rehabilitation Plus Extensive Services RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML, RLX Residents satisfying all of the following three conditions: •Having a minimum activity of daily living (ADL) dependency score of 2 or more. •Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. • Ultra (U)-720+ minutes; 2 disciplines (one 5days; second at least 3days) • Very High (V)-500-719 minutes • High (H)-325-499 minutes • Medium (M)-150-324 minutes • Low (L)-45-149 minutes •While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. Rehabilitation RUA, RUB, RUC, RVA, RVB, RVC, RHA, RHB, RHC, RMA, RMB, RMC, RLA, RLB Residents receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. • Ultra (U)-720+ minutes; 2 disciplines (one 5days; second at least 3days) • Very High (V)-500-719 minutes • High (H)-325-499 minutes • Medium (M)-150-324 minutes • Low (L)-45-149 minutes • ADL Score o 11-16 = C o 6-10 = B o 0-5 = A Extensive Services ES3, ES2, ES1 Residents satisfying the following two conditions: •Having a minimum ADL dependency score of 2 or more. •While a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation.
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SNF PPS: RUG-IV Categories and Characteristics
1
Major RUG-IV Category
RUG-IV Score Characteristics Associated With Major RUG-IV Category
Rehabilitation Plus Extensive Services
RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML, RLX Residents satisfying all of the following three conditions: •Having a minimum activity of daily living (ADL) dependency score of 2 or more. •Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident.
• Ultra (U)-720+ minutes; 2 disciplines (one 5days; second at least 3days) • Very High (V)-500-719 minutes • High (H)-325-499 minutes • Medium (M)-150-324 minutes • Low (L)-45-149 minutes
•While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation.
Residents receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident.
• Ultra (U)-720+ minutes; 2 disciplines (one 5days; second at least 3days) • Very High (V)-500-719 minutes • High (H)-325-499 minutes • Medium (M)-150-324 minutes • Low (L)-45-149 minutes • ADL Score
o 11-16 = C o 6-10 = B o 0-5 = A
Extensive Services ES3, ES2, ES1 Residents satisfying the following two conditions: •Having a minimum ADL dependency score of 2 or more. •While a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation.
SNF PPS: RUG-IV Categories and Characteristics
2
Special Care High HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1 Residents satisfying the following two conditions: •Having a minimum ADL dependency score of 2 or more. •Receiving complex clinical care or have serious medical conditions involving any one of the following: comatose, septicemia, diabetes with insulin injections and insulin order changes, quadriplegia with a higher minimum ADL dependence criterion (ADL score of 5 or more), chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat, fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement, parenteral/IV feeding, or respiratory therapy.
Special Care Low LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1 Residents satisfying the following two conditions: •Having a minimum ADL dependency score of 2 or more. •Receiving complex clinical care or have serious medical conditions involving any of the following: cerebral palsy with ADL dependency score of 5 or more, multiple sclerosis with ADL dependency score of 5 or more, Parkinson’s disease with ADL dependency score of 5 or more, respiratory failure and oxygen therapy while a resident, tube feeding meeting intake requirement, ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers or Stage II pressure ulcers, ulcer treatment with any Stage III or IV pressure ulcer, foot infections or wounds with application of dressing, radiation therapy while a resident, or dialysis while a resident.
Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions or treatments involving any of the following: pneumonia, hemiplegia with ADL dependency score of 5 or more, surgical wounds or open lesions with treatment, burns, chemotherapy while a resident, oxygen therapy while a resident, IV medications while a resident, or transfusions while a resident. Extensive or Special Care with ADL Score of 0 or 1
Behavioral Symptoms and Cognitive Performance
BB2, BB1, BA2, BA1 Residents satisfying the following two conditions: •Having a maximum ADL dependency score of 5 or less. •Having behavioral or cognitive performance symptoms, involving any of the following: difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9), difficulty in making self understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3), hallucinations, delusions, physical behavioral symptoms toward others, verbal behavioral symptoms toward others, other behavioral symptoms, rejection of care, or wandering.
Reduced Physical Function
PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1
Residents whose needs are primarily for support with activities of daily living and general supervision.
CMS’s RAI Version 3.0 Manual CH 3: MDS Items [G]
October 2014 Page G-8
G0110: Activities of Daily Living (ADL) Assistance (cont.) ADL Self-Performance Algorithm
START HERE – Remember to review the instructions for the Rule of 3 and the ADL Self-Performance Coding Level Definitions before using the algorithm. STOP at the first code
that applies when moving down the algorithm.
Did the activity occur at least 1 time?
Did the activity occur 3 or more times?
Did the resident fully perform the ADL activitywithout ANY help or oversight from staff
every time?
Did the resident require full staffperformance every time?
Did the resident require full staff performanceat least 3 times but not every time OR
weight-bearing assistance 3 or more times?
Did the resident require a combination of fullstaff performance and weight-bearing
assistance 3 or more times?*
Did the resident require non-weight-bearingassistance 3 or more times?
Did the resident require a combination of fullstaff performance, weight-bearing
assistance, and/or non-weight-bearingassistance that total 3 or more times?*
Did the resident require oversight,encouragement, or cueing 3 or more times?
If none of the above are met,Code 1 - Supervision
Code 0Independent
Code 4Total
Dependence
Code 3ExtensiveAssistance
Code 2Limited
Assistance
Code 1Supervision
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Code 7Activity
Occurred fewer than3 times
Code 8The ADL Activity (or anypart of the ADL) was not
performed by theresident or staff at all
Instructions for the Rule of 3Exceptions for the Rule of 3:
Code 0, Code 4, and Code 8 – as thedefinition for these coding levels is veryspecific and cannot be entered on theMDS unless it is the level that occurredevery time the ADL occurred.Code 7 – as this code only applies if theactivity occurred fewer than 3 times.
Rule of 3:1. When an activity occurs 3 or more times
at any one level, code that level.2. When an activity occurs 3 or more times
at multiple levels, code the mostdependent level that occurred 3 ormore times.
3. When an activity occurs 3 or more timesand at multiple levels, but not 3 timesat any one level, apply the following:a. Convert episodes of full staff
performance to weight-bearingassistance.
b. When there is a combination of fullstaff performance and weight-bearingassistance that total 3 or more times– code extensive assistance (3). Donot proceed to “c” below if “b” applies.
c. When there is a combination of fullstaff performance/weight-bearingassistance and/or non-weight-bearingassistance that total 3 or more times,code limited assistance (2).
If none of the above are met, codeSupervision (1)
*This box in the algorithm corresponds to a,b, and c under the third Rule of 3 above. Theinstruction in this box only applies when thethird Rule of 3 applies, i.e., an activity occurs3 or more times and at multiple levels, butnot 3 times at any one level (e.g., 2 timesnon-weight-bearing, 2 times weight-bearing).If the coding scenario does not meet thethird Rule of 3, do not apply a, b, or c of thethird Rule of 3, answer “No,” and then continue down the algorithm.
Self Performance "‐", 0, 1, 7, or 8Support any numberADL Score 0
Self Performance "‐", 0, 1, 2, 7, or 8Support "‐", 0, 1, or 8ADL Score 0
4 3 or 4any number "‐", 0, 1, or 2 "‐", 0, 1, or 2 3
3 4
Coding Instructions for ADL Self Performance
2
Bed Mobility ADL Score
1 2 3 4
Eating
"‐", 0, 1, 2, 7, or 8 3 or 4 3 42 or 3 "‐", 0, or 1 2 or 3 2 or 31
Transfer ADL Score
Toilet ADL Score
Total ADL Score (A = 0‐5; B = 6‐10; C = 11‐16)
Eating ADL Score
Bed Mobility, Transfers, & Toilet2 3
Code
0
1
2
3
4
7
8
Code
0
1
2
3
8
Level of Self Performance
The activity did not occur or family and/or non‐facility staff provided care 100% of the time for that activity over the entire seven day look‐back period
Definition
IndependentResident completed activity with no help or over‐sight every time during the seven day look‐back period
SupervisionOversight, encouragement, or cueing was provided three or more times during the seven day look‐back period
Limited Assistance
Resident was highly involved in activity and received physical help in guided maneuvering of limb(s) or other non‐weight bearing assistance on three or more times during the seven day look‐back period
Extensive Assistance
Resident performed part of the activity over the seven day look‐back period, help of the following type(s) was provided three or more times: Weight‐bearing support provided three or more times. Full staff performance of activity during part but not all of the seven day look‐back period
Total Dependence
There was full staff performance of an activity with no participation by resident for any aspect of the ADL activity. The resident must be unwilling or unable to perform any part of the activity over the entire seven day look‐back period
Activity Occurred Only Once or Twice The activity occurred but not three or more times
Activity Did Not OccurThe activity did not occur or family and/or non‐facility staff provided care 100% of the time for that activity over the entire seven day look‐back period
ADL Activity Itself Did Not Occur During the Entire Period
Coding Instructions for ADL SupportCode for the most support provided over all shifts; code regardless of resident's self‐performance classification
Level of Support Definition
No Setup or Physical Assist Resident completed activity with no help or oversight
Setup Help Only
Resident is provided with materials or devices necessary to perform the ADL independently. This can include giving or holding out an item that the resident takes from the caregiver
One Person Physical Assist Resident was assisted by one staff person
Two+ Person Physical Assist Resident was assisted by two or more staff persons
FINAL: RUG-IV Version 1.03.0 Grouper Documentation
Table 9-1. MDS 3.0 Items Used in RUG-IV
RUG Item #
MDS Label Description Length Start
PositionEnd
Position1 A0310A Type of assessment: OBRA 2 270 2712 A0310B Type of assessment: PPS 2 272 2733 A0310C Type of assessment: OMRA 1 274 2744 A0310D Swing bed clinical change assessment 1 275 2755 A2300 Assessment reference date 8 486 4936 A2400B Start date of most recent Medicare stay 8 495 5027 A2400C End date of most recent Medicare stay 8 503 5108 B0100 Comatose 1 511 5119 B0700 Makes self understood 1 515 515
53 K0700B Average fluid intake per day by IV or tube 1 884 88454 K0710A3 Prop calories parenteral/tube feed: 7 days 1 1468 146855 K0710B3 Avg fluid intake per day IV/tube: 7 days 1 1471 147156 M0300B1 Stage 2 pressure ulcers: number present 1 900 90057 M0300C1 Stage 3 pressure ulcers: number present 1 910 91058 M0300D1 Stage 4 pressure ulcers: number present 1 912 91259 M0300F1 Unstaged slough/eschar: number present 1 916 91660 M1030 Number of venous and arterial ulcers 1 940 94061 M1040A Other skin probs: infection of the foot 1 941 94162 M1040B Other skin probs: diabetic foot ulcer(s) 1 942 94263 M1040C Other skin probs: other open lesion(s) on the
foot1 943 943
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FINAL: RUG-IV Version 1.03.0 Grouper Documentation
RUG Item #
MDS Label Description Length Start
PositionEnd
Position64 M1040D Other skin probs: lesions not ulcers, rashes,
cuts1 944 944
65 M1040E Other skin probs: surgical wound(s) 1 945 94566 M1040F Other skin probs: burns (second or third
degree)1 946 946
67 M1200A Skin/ulcer treat: pressure reduce device for chair
1 948 948
68 M1200B Skin/ulcer treat: pressure reducing device for bed
1 949 949
69 M1200C Skin/ulcer treat: turning/repositioning 1 950 95070 M1200D Skin/ulcer treat: nutrition/hydration 1 951 95171 M1200E Skin/ulcer treat: ulcer care 1 952 95272 M1200F Skin/ulcer treat: surgical wound care 1 953 95373 M1200G Skin/ulcer treat: application of dressings 1 954 95474 M1200H Skin/ulcer treat: apply ointments/medications 1 955 95575 M1200I Skin/ulcer treat: apply dressings to feet 1 956 95676 N0350A Insulin: insulin injections 1 959 95977 N0350B Insulin: orders for insulin 1 960 96078 O0100A2 Treatment: chemotherapy - while resident 1 970 97079 O0100B2 Treatment: radiation - while resident 1 972 97280 O0100C2 Treatment: oxygen therapy - while resident 1 974 97481 O0100E2 Treatment: tracheostomy care - while resident 1 978 97882 O0100F2 Treatment: vent/respirator - while resident 1 980 98083 O0100H2 Treatment: IV medications - while resident 1 984 98484 O0100I2 Treatment: transfusions - while resident 1 986 98685 O0100J2 Treatment: dialysis - while resident 1 988 98886 O0100M2 Treatment: isolate/quarantine - while resident 1 993 99387 O0400A1 Speech-language/audiology: individ minutes 4 1008 101188 O0400A2 Speech-language/audiology: concur minutes 4 1012 101589 O0400A3 Speech-language/audiology: group minutes 4 1016 101990 O0400A4 Speech-language/audiology: number of days 1 1020 102091 O0400A5 Speech-language/audiology: start date 8 1021 102892 O0400A6 Speech-language/audiology: end date 8 1029 103693 O0400B1 Occupational therapy: individ minutes 4 1037 104094 O0400B2 Occupational therapy: concur minutes 4 1041 1044
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FINAL: RUG-IV Version 1.03.0 Grouper Documentation
RUG Item #
MDS Label Description Length Start
PositionEnd
Position95 O0400B3 Occupational therapy: group minutes 4 1045 104896 O0400B4 Occupational therapy: number of days 1 1049 104997 O0400B5 Occupational therapy: start date 8 1050 105798 O0400B6 Occupational therapy: end date 8 1058 106599 O0400C1 Physical therapy: individ minutes 4 1066 1069100 O0400C2 Physical therapy: concur minutes 4 1070 1073101 O0400C3 Physical therapy: group minutes 4 1074 1077102 O0400C4 Physical therapy: number of days 1 1078 1078103 O0400C5 Physical therapy: start date 8 1079 1086104 O0400C6 Physical therapy: end date 8 1087 1094105 O0400D2 Respiratory therapy: number of days 1 1099 1099106 O0420 Distinct calendar days of therapy 1 1484 1484107 O0450A Resumption of therapy code 1 1429 1429108 O0500A Range of motion (passive): number of days 1 1110 1110109 O0500B Range of motion (active): number of days 1 1111 1111110 O0500C Splint or brace assistance: number of days 1 1112 1112111 O0500D Bed mobility training: number of days 1 1113 1113112 O0500E Transfer training: number of days 1 1114 1114113 O0500F Walking training: number of days 1 1115 1115114 O0500G Dressing and/or grooming training: number of
days1 1116 1116
115 O0500H Eating and/or swallowing training: number of days
1 1117 1117
116 O0500I Amputation/prosthesis training: number of days 1 1118 1118117 O0500J Communication training: number of days 1 1119 1119
Section 10. Standard Case Mix Index (CMI) Sets
Seven standard CMIs sets will be available for index maximizing classification with this Logic Version of the RUG-IV Grouper. The CMI values for the CMI sets are provided in separate documents that are described above (see Section 2: Files Available with the Grouper package).