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Understanding the changes under RUG-IV

MDS 3.0 Update, November 16, 2009

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RUG-IV is scheduled for implementation October 1, 2010, along with the MDS 3.0. Some changes that RUG-IV will bring include:

• Fever with feeding tube will be added to the Special Care High category
• CMS clarified that dehydration has been deleted as a qualifier in any category, including the Special Care and Clinically Complex categories
• Respiratory failure in combination with oxygen therapy while a SNF resident will be added to the Special Care Low category
• Oxygen therapy alone while a SNF resident will be moved to the Clinically Complex category
• A patient will also qualify in the Special Care Low category if one of the following is present, along with two or more skin treatments:

                 -Two or more venous/arterial ulcers
                 -One Stage 2 pressure ulcer and one venous/ arterial ulcer

The RUG-IV model will modify the eight-level hierarchy of major patient types by dividing the Special Care category into Special Care High and Special Care Low and combining the Cognitive Performance and Behavioral Symptoms categories. RUG-IV will also increase the number of case-mix groups from 53 to 66. CMS believes that the expanded RUG-IV model “is more sensitive to differences in patient complexity and the SNF resources needed to provide quality of care than the existing RUG-III model,” according to the SNF PPS proposed rule for FY 2010.

Under RUG-IV, the activities of daily living (ADL) index will range from 0–16, instead of 4–18 under RUG-III. The revised ADL index will improve accuracy in scoring the functional status of residents, according to the proposed rule.

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