SNF PPS: RUG-IV Categories and Characteristics

1 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.

2 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 .

3 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. Clinically Complex CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1 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.

4 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 Manual CH 3: MDS Items [G] October 2014 Page G-8 G0110: Activities of Daily Living (ADL) Assistance (cont.)

5 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 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 staffevery time?Did the resident require full staffperformance every time?Did the resident require full staff performanceat least 3 times but not every time ORweight-bearing assistance 3 or more times?Did the resident require a combination of fullstaff performance and weight-bearingassistance 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-bearingassistance, and/or non-weight-bearingassistance that total 3 or more times?*Did the resident require oversight,encouragement, or cueing 3 or more times?

6 If none of the above are met,Code 1 - SupervisionCode 0 IndependentCode 4 TotalDependenceCode 3 ExtensiveAssistanceCode 2 LimitedAssistanceCode 1 SupervisionYesYesYesYesYesYesYesYesYesNo NoNoNoNoNoNoCode 7 ActivityOccurred fewer than3timesCode 8 The ADL Activity (or anypart of the ADL) was notperformed by theresident or staff at allInstructions for the Rule of 3 Exceptions for the Rule of 3:x 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 occurredeverytime the ADL Code 7 as this code only applies if theactivity occurred fewer than 3 of 3:1. When an activity occurs3 or more timesat any one level, code that When an activity occurs3 or more timesat multiple levels, code the mostdependent level that occurred 3 ormore When an activity occurs3 or more timesand at multiple levels, but not 3 timesat any one level, apply the following:a. Convert episodes of full staffperformance to When there is a combination of fullstaff performance and weight-bearingassistance that total 3 or more times code extensive assistance (3).

7 Donot proceed to c below if b 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 boxonlyapplies when thethird Rule of 3 applies, , an activity occurs3 or more times and at multiple levels, butnot 3 times at any one level ( , 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 NameARDBed MobilitySelf Performance0123478 Support01238 TransferSelf Performance0123478 Support01238 ToiletSelf Performance0123478 Support01238 EatingSelf Performance0123478 Support01238 Self Performance" ", 0, 1, 7, or 8 Supportany numberADL Score0 Self Performance" ", 0, 1, 2, 7, or 8 Support" ", 0, 1, or 8 ADL Score0 Total ADL Score (A = 0 5; B = 6 10.)

8 C = 11 16)ADL Score WorksheetBed Mobility ADL ScoreTransfer ADL ScoreToilet ADL ScoreEating ADL Score2 or 3" ", 0, or 12 or 32 or 31234" ", 0, 1, 2, 7, or 83 or 43 42any number13" ", 0, 1, or 224" ", 0, 1, or 23 Bed Mobility, Transfers, & ToiletEating3 or 434 ARD RUG billedADL audit score match = Score WorksheetTotal AuditedTotal Match% MatchADL SCORE AUDIT TOOLP atient NameSmithJonesMartinPatient NameARDBed MobilitySelf Performance0123478 Support01238 TransferSelf Performance0123478 Support01238 ToiletSelf Performance0123478 Support01238 EatingSelf Performance0123478 Support01238 Self Performance" ", 0, 1, 7, or 8 Supportany numberADL Score0 Self Performance" ", 0, 1, 2, 7, or 8 Support" ", 0, 1, or 8 ADL Score043 or 4any number" ", 0, 1, or 2" ", 0, 1, or 2334 Coding Instructions for ADL Self Performance2 Bed Mobility ADL Score1 234 Eating" ", 0, 1, 2, 7, or 83 or 43 42 or 3" ", 0, or 12 or 32 or 31 Transfer ADL ScoreToilet ADL ScoreTotal ADL Score (A = 0 5; B = 6 10.

9 C = 11 16)Eating ADL ScoreBed Mobility, Transfers, & Toilet23 Code0123478 Code01238 Level of Self PerformanceThe 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 periodDefinitionIndependentResident completed activity with no help or over sight every time during the seven day look back periodSupervisionOversight, encouragement, or cueing was provided three or more times during the seven day look back periodLimited AssistanceResident 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 periodExtensive AssistanceResident 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 periodTotal DependenceThere was full staff performance of an activity with no participation by resident for any aspect of the ADL activity.

10 The resident must be unwilling or unable to perform any part of the activity over the entire seven day look back periodActivity Occurred Only Once or TwiceThe activity occurred but not three or more timesActivity 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 periodADL Activity Itself Did Not Occur During the Entire PeriodCoding Instructions for ADL SupportCode for the most support provided over all shifts; code regardless of resident's self performance classificationLevel of SupportDefinitionNo Setup or Physical AssistResident completed activity with no help or oversightSetup Help OnlyResident 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 caregiverOne Person Physical AssistResident was assisted by one staff personTwo+ Person Physical AssistResident was assisted by two or more staff persons#1 PPS Day12345678 Calenday Day14 Feb 15 Feb 16 Feb 17 Feb 18 Feb19 Feb20 Feb 21 FebDay of WeekSunday Monday Tuesday WednesdayThursday Friday Saturday SundayPT Individual5275757880PT ConcurrentPT GroupOT Individual7578805275OT ConcurrentOT GroupST IndividualST ConcurrentST Group#2 PPS Day12345678 Calenday Day14 Feb 15 Feb 16 Feb 17 Feb 18 Feb19 Feb20 Feb 21 FebDay of WeekSunday Monday Tuesday WednesdayThursday Friday Saturday SundayPT Individual5260606365PT Concurrent30303030PT GroupOT Individual7578805275OT ConcurrentOT GroupST IndividualST ConcurrentST Group#3 PPS Day12345678 Calenday Day14 Feb 15 Feb 16 Feb 17 Feb 18 Feb19 Feb20 Feb 21 FebDay of