Long-Term Care

CMS works toward building MDS 3.0 and partial RUG-IV infrastructure

Contemporary Long-Term Care Weekly, May 27, 2010

In a notification released May 24 via the listserv, CMS addressed the immediate need for a grouper that takes into account the partial elements of RUG-IV and the MDS 3.0, which will be implemented October 1, 2010. Until the new payment infrastructure is completed, CMS will apply interim payment rates.

“Once the necessary infrastructure is in place, we will then retroactively adjust the rates to reflect a hybrid RUG-III (HR-III) system which incorporates RUG-IV’s specific revision on concurrent therapy and the look-back period within the framework of the existing 53-group RUG-III system, along with the use of MDS 3.0,” the notification says.

The delayed implementation of RUG-IV in its entirety until fiscal year 2012 is mandated in section 10325 of the Patient Protection and Affordable Care Act (PPACA). Legislation is currently pending in Congress that would repeal section 10325 of the PPACA. If this legislation passes, RUG-IV will be implemented in full on October 1, 2010, as originally planned, and the need for a new grouper will be eliminated.

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