HOMEWORK HCA 345

HOMEWORK HCA 345
Questions 1 and 2 are worth 2.5 points. The remaining questions are worth 10 points each. What is the Medicaid case mix rate for Summit Manor Health and Rehabilitation? ____________ The poor public image of nursing homes is slowly changing, which also impacts emerging professionals and their misconceptions surrounding the pursuit of nursing home administration as a future career path. There are a variety of reasons for the increasing popularity of nursing home leadership as a career choice. Provide one of those reasons below. ____________________________________________________________________________________________________________________________________________________________ In some situations, there can be limited healthcare options for individuals with Medicaid. Explain one of those reasons below: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If you are caring for someone with dementia, it is important to know their life story. Explain what that means below. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Read the information provided about the resident. Then answer the following questions. Mr. Wright was discharged from the hospital and admitted as a resident at Auburn Health Care in Auburn, KY. He has both Medicare and Medicaid. His stay is currently covered under Medicare Part A as a skilled resident because he is receiving occupational therapy 5 days a week for a total of 500 minutes per week (rehabilitation very high) and also receives tracheostomy care (an extensive service). He has an ADL score of 8. Fill in the following information for Mr. Wright’s current reimbursement: RUG Category: _______________________________ RUG IV: ________ Daily Rate: Mr. Wright is no longer receiving any type of therapy but continues to receive tracheostomy care. His ADL score is the same. Fill in the following information for Mr. Wright’s new reimbursement: RUG Category: _________________________________ RUG IV: _______ Daily Rate: _______ Mr. Wright has exhausted his Medicare Part A benefits and will now have his nursing facility stay paid by Medicaid. What rate, per day, will the facility now receive for his stay? *WHAT IS THE DIFFERENCE in reimbursement rate for Mr. Wright, per day, from his first daily rate (when first admitted to the nursing facility) to today (as a Medicaid stay)? _______ *WHAT IS THE LOSS/GAIN IN REVENUE OVER 30 DAYS? ________ As the Licensed Nursing Home Administrator (LNHA), why is it important for you to understand the reimbursement system? Provide at least 3 DIFFERENT reasons below: _A.__________________________________________________________________________________________________________________________________________________________ _B._________________________________________________________________________________________________________________________________________________________ _C._________________________________________________________________________________________________________________________________________________________ Nursing facility care is “need” driven, not “want” driven. Explain what this means. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HOMEWORK HCA 345
SYNERTX, a national provider of contract rehabilitation services and an industry leader in regulatory expertise, brings you the 2016 SNF Prospective Paym ent System (PPS) rates effective October 1, 2015. Rate Class Payment Amount Rate Class Payment Amount RUX $678.22 HB1 $291.90 RUL $664.42 LE2 $360.91 RUC $525.03 LD2 $347.11 RUB $525.03 LC2 $305.70 RUA $446.35 LB2 $290.52 RVX $595.91 LE1 $302.94 RVL $537.95 LD1 $291.90 RVC $444.10 LC1 $258.78 RVB $388.89 LB1 $247.73 RVA $387.51 CE2 $322.26 RHX $533.68 CD2 $305.70 RHL $478.47 CC2 $268.43 RHC $381.86 CB2 $249.12 RHB $345.98 CA2 $211.85 RHA $307.33 CE1 $297.42 RMX $485.00 CD1 $280.86 RML $446.35 CC1 $249.12 RMC $331.80 CB1 $231.17 RMB $312.48 CA1 $198.05 RMA $260.04 BB2 $224.27 RLX $422.14 BA2 $187.01 RLB $317.25 BB1 $214.61 RLA $208.22 BA1 $178.73 ES3 $584.49 PE2 $297.42 ES2 $458.90 PD2 $280.86 ES1 $410.59 PC2 $242.21 HE2 $396.79 PB2 $206.33 HD2 $371.95 PA2 $171.82 HC2 $351.24 PE1 $283.62 HB2 $347.11 PD1 $267.06 HE1 $330.54 PC1 $231.17 HD1 $311.22 PB1 $198.05 HC1 $294.66 PA1 $164.93 SYNERTX makes no expressed or implied warranty on t he accuracy of the calculated rates. Your use of these rates and the information it provides is therefore undertaken at your own risk, and you hereby agree t o hold SYNERTX harmless for any losses or damages that may result from error or omission. These rates are based on the Federal Register Vol. 80, No. 149 dated August 4, 2015 – Medicare Program ; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2016; Notice. The information provided should be verified by your own Accountant or Medicare Administrative Contract or (MAC) for accuracy. www.SYNERTX.com 2016 Prospective Payment System (PPS) RUG IV Rates Effective October 1, 2015 These are the RURAL rates effective for zAll Others county in KY. (W age Factor: 0.7742) 7540 North 19th Avenue Phoenix, Arizona 85021 (888) 873-4221 fax (888) 543-2289
HOMEWORK HCA 345
Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days Arbor Place of Clinton $168.20 50% Auburn Health Care $159.31 50% Baptist Convalescent Center, Inc. $189.26 50% Baptist Health La Grange $189.36 50% Barbourville Health & Rehabilitation Center $197.89 75% Barren County Health Care Center $163.51 75% Beaver Dam Nursing & Rehab Ctr, Inc. $179.00 75% Belle Meade Home NF $166.89 50% Berea Health Care Center $188.77 50% Bluegrass Care & Rehabilitation Center $207.98 50% Bourbon Heights, Inc. $175.62 75% Bowling Green Nursing & Rehabilitation Center $182.83 50% Boyd Nursing & Rehab Center $201.42 75% Bracken Co Nursing & Rehabilitation Center $186.00 50% Bradford Heights Health & Rehab Center, Inc $198.48 50% Bradford Square Care and Rehabilitation Center $167.42 75% Brandenburg Nursing and Rehabilitation Center $172.79 50% Breckinridge Memorial Hospital, HB $161.66 50% Breckinridge Place $186.04 50% Bridge Point Care and Rehabilitation Center $212.65 75% Brighton Cornerstone Health Care $155.67 50% Brownsboro Hills Nursing Home $196.60 50% Cal Turner Rehab and Specialty Care $168.10 75% Calvert City Convalescent Center, Inc. $162.98 50% Cambridge Place Group, LLC $203.14 50% Campbellsville Nursing and Rehabilitation Center $185.78 50% Carmel Home $185.62 75% Carmel Manor $203.62 75% Carter Nursing & Rehabilitation Center $209.09 75% Cedar Ridge Health Campus $163.88 50% Cedars of Lebanon Nursing Center $158.46 50% Charleston Health Care Center $169.93 50% Christian Care Center of Kuttawa $167.03 50% Christian Care Center of Lancaster $165.36 75% Christian Health Center – West, Inc. $180.28 50% Christian Health Center of Bowling Green $168.10 75% Christian Health Center of Corbin $168.66 50% Christian Health Center of Hopkinsville $192.95 50% Christian Health Center of Louisville $191.89 50% Christian Heights Nursing and Rehabilitation Center $200.70 50% January 1, 2015 Rates Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 1 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates Christopher East Healthcare Center $183.48 50% Clark Regional Medical Center $182.82 50% Clinton Co Care & Rehabilitation Center $181.22 50% Clinton-Hickman County ICF $159.85 50% Colonial Health & Rehab Center $169.81 50% Colonial Manor Rehabilitation & Nursing Center $166.92 50% Corbin Health & Rehabilitation Center $184.33 75% Countryside Care and Rehabilitation Center $176.64 50% Covington’s Convalescent Center $169.32 50% Creekwood Place Nursing & Rehab Center, Inc. $175.48 50% Crestview Care and Rehabilitation Center $173.99 50% Crittenden Co. Health & Rehab Center $178.05 50% Cumberland Nursing and Rehabilitation Center $185.84 75% Cumberland Valley Manor $171.61 75% Danville Centre for Health & Rehabilitation $164.81 50% Dawson Springs Health and Rehabilitation Ctr. $156.55 50% Diversicare of Seneca Place $183.24 50% DJ Letcher Manor LLC $167.76 50% Dover Manor, Inc. $175.30 50% Edgemont Healthcare $161.93 50% Edgewood Estates $162.73 75% Edmondson Care and Rehabilitation Center $171.33 50% Elizabethtown Nursing & Rehabilitation Center $182.48 50% Elliott Nursing and Rehab Center $172.24 75% Episcopal Church Home $173.88 50% Essex Nursing and Rehabilitation Center $189.29 50% Fair Oaks Health Systems $166.70 75% Florence Park Care Center $209.79 50% Fordsville Nursing and Rehabilitation Center $176.68 50% Fountain Circle Care and Rehabilitation $206.53 50% Franciscan Healthcare Center $197.26 50% Franklin-Simpson Nursing and Rehabilitation Center $171.26 50% Friendship Health & Rehab, LLC $197.43 50% Gallatin Health Care $197.81 50% Georgetown Manor Health Care Center $178.32 50% Glasgow Health & Rehab Center $163.49 50% Glenview Health Care Facility $147.86 50% Golden LivingCenter-Camelot $195.55 75% Golden LivingCenter-Frankfort $172.48 50% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 2 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates Golden LivingCenter-Green Hill $168.33 50% Golden LivingCenter-Hillcreek $208.47 50% Golden LivingCenter-Mt. Holly $202.59 50% Golden LivingCenter-St Matthews $191.44 50% Golden LivingCenter-Stanford $174.48 50% Golden LivingCenter-Vanceburg $171.50 75% Good Samaritan Center $190.85 50% Good Shepherd Community Nursing Center $170.08 50% Grand Haven Nursing Home $159.27 75% Grant Manor Care and Rehabilitation Center $218.28 75% Grayson Manor $173.48 50% Green Acres Healthcare, Inc. $160.89 50% Green Meadows Health Care Center, Inc $184.72 50% Green Valley Health & Rehab Center $165.03 50% Greenwood Nursing and Rehabilitation Center $171.49 75% Hardinsburg Nursing and Rehabilitation Center $176.19 75% Harlan Health & Rehabilitation Center $180.02 75% Harrodsburg Health & Rehabilitation Center $164.26 50% Hart County Health Care Center $167.50 50% Haws Memorial Nursing & Rehabilitation Center $169.18 50% Hazard Health & Rehabilitation Center $183.61 75% Hearthstone Place $157.58 50% Heartland Villa Care and Rehabilitation Center $184.79 75% Helmwood Healthcare Center $184.79 50% Henderson Nursing and Rehabilitation Center $213.01 50% Heritage Hall Health & Rehabilitation Center $165.92 50% Heritage Manor Healthcare Center $172.46 50% Hermitage Care & Rehabilitation Center $219.59 50% Hicks Golden Years Nursing Home $171.03 75% Highlands Health and Rehabilitation Center $191.91 50% Highlandspring of Ft Thomas $191.24 50% Hillcrest Health & Rehabilitation Center $185.61 75% Hillside Villa Care and Rehabilitation Ctr. $176.63 50% Homestead Nursing Center Lexington $190.78 75% Homestead Nursing Center New Castle $164.75 50% Hopkins Care and Rehabilitation Center $171.76 75% Hurstbourne Care Center at Stony Brook $215.77 50% Hyden Health & Rehabilitation Center $192.24 75% Irvine Nursing & Rehabilitation Center $179.06 50% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 3 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates Jackson Manor $188.66 50% James B. Haggin Memorial Hospital, HB $153.59 50% Jefferson Manor $181.11 50% Johnson Mathers Nursing Home, HB $161.25 50% Kensington Manor Care and Rehabilitation Center $177.93 50% Kenwood Health and Rehabilitation Center $217.20 50% Kindred Nursing and Rehabilitation-Bashford $183.01 75% Kindred Nursing and Rehabilitation-Maple $174.48 75% Kingsbrook Lifecare Center $206.24 50% Klondike Care and Rehabilitation Center $203.02 50% Knott County Nursing Home $186.05 75% Lake Way Nursing and Rehabilitation Center $167.50 50% Laurel Creek Health Care Center $171.92 50% Laurel Heights Home for the Elderly $194.56 75% Lee County Care and Rehabilitation Center $189.27 50% Lexington Country Place $176.55 50% Liberty Care and Rehabilitation Center $177.10 75% Life Care Center of Bardstown $195.23 50% Life Care Center of LaCenter $172.09 50% Life Care Center of Morehead $157.95 75% Loretto Motherhouse Infirmary $145.66 75% Madison Health and Rehabilitation Center $208.99 50% Madonna Manor, Inc $187.13 50% Magnolia Village Care and Rehabilitation Center $175.97 75% Martin County Healthcare Facility $170.08 50% Masonic Home of Louisville $187.24 50% Masonic Home of Shelbyville $176.65 50% Mayfair Manor $201.25 50% Maysville Nursing and Rehabilitation Center $163.20 50% McCracken Nursing and Rehabilitation Center $178.48 50% McCreary Health & Rehabilitation Center $182.12 50% Meadowview Health & Rehab Center $194.48 50% Mercy Sacred Heart, Inc. $180.43 50% Metcalfe Health Care Center $164.00 75% Middlesboro Nursing and Rehabilitation Facility $184.06 75% Mills Health & Rehab Center $174.61 50% Monroe Health & Rehab Center $170.40 50% Morganfield Nursing and Rehabilitation Center $183.47 75% Morgantown Care & Rehab Center $179.17 75% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 4 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates Mountain Manor of Paintsville $183.08 50% Mountain View Health Care Center $162.73 50% Mountain View Nursing & Rehabilitation Center $162.19 50% Muhlenberg Community Hospital, HB $171.63 50% Nazareth Home, Inc. $195.21 75% NHC Healthcare Glasgow $158.11 50% NHC Healthcare Madisonville $159.65 50% Nim Henson Geriatric Center $152.74 50% North Hardin Health & Rehab Center $169.01 50% Northpoint Lexington Healthcare Center $197.99 75% Oakmont Manor $219.45 50% Oakview Nursing & Rehabilitation Center $177.86 50% Owensboro Place Care and Rehabilitation Ctr. $209.49 50% Owenton Manor Care and Rehabilitation Center $175.15 50% Owsley County Health Care Center $162.02 50% Paducah Care and Rehabilitation Center $174.76 50% Park Terrace Health Campus $195.72 50% Parkview Nursing and Rehab Ctr. Paducah $162.88 50% Parkview Nursing and Rehab Ctr. Pikeville $181.27 50% Parkway Medical Center $208.91 50% Pine Meadows Health Care LLC $189.44 50% Pineville Community Hospital, HB $197.54 50% Pioneer Trace Nursing Home $159.64 50% Prestonsburg Health Care Center $190.92 50% Princeton Health & Rehab Center, Inc $166.28 50% Professional Care Health & Rehab Center $169.56 50% Providence Pavilion $202.42 50% Redbanks Colonial Terrace, Inc. $167.61 50% Redbanks Nursing Home $204.34 50% Regency Care and Rehabilitation Center $200.64 50% Regis Woods Care and Rehabilitation Center $203.40 50% Richmond Place Rehab & Health Center $207.76 50% Ridgeway Nursing & Rehabilitation Facility $162.62 50% Ridgewood Terrace Health and Rehab. Center $175.52 75% River Valley Nursing Home $172.05 75% River’s Bend Retirement Community $166.12 50% River’s Edge Nursing & Rehabilitation Center $199.46 50% Riverside Care and Rehabilitation $167.42 75% Riverview Health Care Center $201.92 50% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 5 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates Robertson Manor LLC $164.20 50% Rockcastle Health and Rehabilitation Center, Inc $187.97 50% Rockford Manor $195.60 50% Rose Manor $159.77 75% Rosedale Manor $190.15 50% Royal Manor, Inc. $194.73 50% Salem Springlake Health & Rehab Center $180.05 50% Salyersville Nursing and Rehabilitation Center $188.07 50% Sansbury Care Center, Inc. $155.55 75% Sayre Christian Village Nursing Home $202.06 50% Shady Lawn Nursing and Rehabilitation Center $171.76 50% Signature Healthcare at Glenview $204.18 50% Signature HealthCARE at Hillcrest $206.55 50% Signature HealthCARE of Bowling Green $166.15 50% Signature HealthCARE of Cherokee Park $212.69 50% Signature HealthCARE of East Louisville $211.13 50% Signature HealthCARE of Elizabethtown $168.89 50% Signature HealthCARE of Georgetown $197.41 50% Signature HealthCARE of Pikeville $191.79 50% Signature HealthCARE of South Louisville $208.55 50% Signature HealthCARE of Spencer County $179.26 75% Signature HealthCARE of Trimble County $180.19 50% Somerset Nursing and Rehabilitation $164.61 50% Somerwoods Nursing and Rehabilitation Center $176.84 50% South Shore Nursing & Rehab Center $205.75 50% Spring Creek Health Care $164.06 50% Spring View Health & Rehab Center $168.90 75% Springfield Nursing and Rehabilitation Center $173.90 50% Springhurst Health and Rehab $186.00 50% St. Joseph’s Home for the Aged $172.30 75% Stanton Nursing and Rehabilitation Center $178.48 50% Summerfield Health & Rehabilitation Center $193.90 50% Summit Manor Health & Rehabilitation Center $162.56 50% Sunrise Manor Nursing Home $186.81 50% Superior Care Home, Inc. $187.79 50% The Forum at Brookside $168.92 50% The Grandview $179.38 50% The Heritage $181.34 75% The Jordan Center $166.14 50% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 6 of 7 Commonwealth of Kentucky Department for Medicaid Services Prepared by Myers and Stauffer LC, January 26, 2015 Facility Final Medicaid Rate % of Rate for Bed Reserve Days January 1, 2015 Rates The Richwood $199.89 50% The Terrace Nursing & Rehabilitation Ctr. $200.01 75% The Village of Lebanon II $157.42 50% The Willows at Citation $254.29 50% The Willows at Hamburg $201.39 50% Tradewater Health and Rehabilitation Center $169.64 50% Treyton Oak Towers $206.36 50% Tri-Cities Nursing and Rehabilitation Center $170.93 50% Twin Rivers Nursing and Rehabilitation Center $204.14 50% Village Care Center $191.56 50% Villaspring Of Erlanger $203.01 50% Wellington Parc of Owensboro $180.22 75% Wesley Manor Nursing Center $181.61 75% West Liberty Nursing & Rehabilitation Ctr. $174.23 50% Westminster Terrace Center $193.15 50% Williamsburg Health and Rehabilitation Center $193.94 75% Williamson ARH, HB $178.63 50% Windsor Care Center $164.69 50% Wolfe County Health & Rehabilitation Center $189.19 75% Woodcrest Nursing and Rehabilitation Center $220.96 50% Woodland Oaks $197.52 75% Wurtland Nursing & Rehabilitation Center $186.42 50% Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 7 of 7
HOMEWORK HCA 345
Compliments of ADL Data Systems, Inc. ADL = 2 — 16RUG-IV ADL Score End Splits LE2 LE115—16 15—16 Depression No Depression LD2 LD1 11—14 11—14 Depression No Depression LC2 LC1 6 —10 6 —10 Depression No Depression LB2 LB1 2—5 2—5Depression No Depression RUG-IV ADL Score End Splits BB2 BB1 2 — 5 2 — 5 ≥ 2 restorative nursing < 2 restorative nursing ES3 ES2 ES1 B BA2 BA1 0 — 1 0 — 1 ≥ 2 Restorative nursing < 2 restorative nursing RUG-IV ADL Score End Splits G0110 (1)Self Performance G0110 (2)Staff Support ADLScore G0110 (1)Self G0110 (2)Staff Support ADLScore Eating ____ ______ ____ ______ 0 1 2 3 4 any number = any number = -, 0, 1, or 2 = -, 0, 1, or 2 = 3 = -, 0, 1, 2, 7 or 8 AND -, 0, 1, 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 -, 0, 1, 7, or 8 AND 2 AND 3 AND 4 AND 3 or 4 AND Bed Mobility (G0110A) = Transfer (G0110B) = Toilet Use (G0110I) = Eating (G0110H) = K0700A is 51% or more of total calories OR K0700A is 26% to 50% of total calories AND K0700B is 501 cc or more per day fluids enteral intake in the last 7 days • Pressure relieving chair/bed++ • Turning/Repositioning • Nutrition or hydration intervention • Ulcer Care • Application of Dressing (Not to feet) • Application of Ointment (Not to feet) ++ Count as one service if both are provided • Surgical Wound Care • Application of Dressing (Not to feet) • Application of Ointment (Not to feet) • Urinary toileting program and/or bowel toileting program ++ • Passive and/or active ROM ++ • Splint or brace assistance • Bed mobility and/or walking training ++ • Transfer training • Dressing and/or grooming training • Eating and/or swallowing training • Amputation/prostheses care • Communication training ++ Count as one service even if both provided 15 — 16 15 — 16 11 — 14 11 — 14 6 — 10 6 — 102 — 5 2 — 5 0 — 1 0 — 1 RUG-IV Late Loss ADL Calculations (Enter ADL score for each item below) Bed Mobility, Toilet and Transfer Use PE2 PE1 PD2 PD1 PC2 PC1 PB2 PB1 PA2 PA1 HE2 HE1 HD2 HD1 HC2 HC1 HB2 HB1 15-16 15-16 11-14 11-14 6-10 6-10 2-5 2-5 ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative CATEGORY VIII- Reduced Physical Function ADL = 0 — 16 Depression No Depression Depression No Depression Depression No Depression Depression No Depression • Residents who do not meet the conditions in any of the previous categories • Behavioral Symptom & Cognitive Performance with RUG-IV ADL score > 5 • Restorative Nursing Services used for end splits • Comatose and completely ADL dependent or ADL did not occur • Septicemia •Diabetes with both Insulin injections for all 7 days and insulin order changes on 2 or more days • Quadriplegia and ADL score >= 5 • Chronic obstructive pulmonary disease (COPD) and shortness of breath when lying flat • Fever with one of the following: Pneumonia, Vomiting, Weight loss or Feeding tube • Parenteral/IV feedings • Respiratory therapy for 7 days RUG-IV Cheat Sheet CATEGORY VI- CLINICALLY COMPLEX • Pneumonia • Hemiplegia and ADL score ≥ 5 • Surgical wounds or open lesions with treatment • Burns • Chemotherapy while a resident Category V — Special Care Low Ultra High Criteria 720 minutes or more (total) of therapy per week 1 Discipline for at least 5 days A second discipline for at least 3 days 144 minutes or more if MSSAI = YES Very High Criteria 500 minutes or more (total) of therapy per week At least 1 discipline for at least 5 days 100 to 143 minutes if MSSAI = YES High Criteria 325 minutes or more (total) of therapy per week At least 1 discipline for at least 5 days 65 to 99 minutes if MSSAI = YES Medium Criteria 150 minutes or more (total) of therapy per week At least 5 days of any combination of the 3 disciplines 30 to 64 minutes if MSSAI = YES Low Criteria 45 minutes or more (total) of therapy per week At least 3 days of any combination of 3 disciplines 2 or more Restorative Nursing Services received, each for 6 or more days for at least 15 minutes. 15 to 29 minutes if MSSAI = YES AND AND AND AND AND AND AND Includes calculations to determine resident late loss ADL Score. For specific info on RUG-IV, please refer to Chapter 6 in the LTC RAI User’s Manual Version 3.0. Rehabilitation Ultra High PLUS Extensive Service(s) Rehabilitation Very High PLUS Extensive Service(s) Rehabilitation High PLUS Extensive Service(s) Rehabilitation Medium PLUS Extensive Service(s) Rehabilitation Low PLUS Extensive Service(s) CE2 CE1 CD2 CD1 CC2 CC1 CB2 CB1 CA2 CA1 • Cerebral palsy with ADL score ≥ 5 • Multiple sclerosis with ADL score ≥ 5 • Parkinson’s disease with ADL score ≥ 5 • Respiratory failure and oxygen therapy while a resident • Feeding tube • 2 or more stage 2 pressure ulcers with 2 or more selected skin treatments • Any stage 3 or 4 pressure ulcer with two or more selected ulcer treatments • 2 or more venous/arterial ulcers with two or more selected ulcer treatments • 1 stage 2 pressure ulcer and 1 venous/arterial ulcer with 2 or more selected ulcer treatments • Foot infection, diabetic foot ulcer or other open lesion of foot with application of dressings to the feet • Radiation treatment while a resident • Dialysis treatment while a resident Signs of depression used for end splits: PHQ score ≥10 ADL = 0 — 16 • Residents with Extensive Services, Special Care High or Special Care Low 15 — 16 15 — 16 11 — 14 11 — 14 6 — 10 6 — 102 — 5 2 — 5 0 — 1 0 — 1 Depression No Depression Depression No Depression Depression No Depression Depression No Depression Depression No Depression • Oxygen while a resident • IV medications while a resident • Transfusions while a resident Signs of depression used for end splits: PHQ • Residents has a cognitive impairment BIMS score ≤ 9 or CPS ≥ 3 • Hallucinations • Delusions • Residents displaying one of the following symptoms: •• Physical or verbal behavioral symptoms toward others •• Other behavioral symptoms •• Rejection of care •• Wandering • Restorative Nursing Services used for end splits RUX RUL RVXRVL RHX RHL RMX RML RLX RUC RUB RUA 11 — 16 2 — 10 11 — 16 2 — 10 11 — 16 2 — 10 11 — 16 2 — 10 2 — 16 11 — 16 6 — 100 — 5 Tracheostomy care AND Ventilator or Respirator (while a resident) Tracheostomy care OR Ventilator or Respirator (while a resident) Infection Isolation (while a resident) RVC RVB RVA RHC RHB RHA RMC RMB RMA RLB RLA 11 — 16 6 — 100 — 5 11 — 16 6 — 100 — 5 11 — 16 6 — 100 — 5 11 — 16 0 — 10 CATEGORY VII – Behavioral Symptoms and Cognitive Performance ADL = 0 — 5 RUG -IV ADL Score End Splits ADL = 0 — 16 RUG -IV ADL Score ADL = 2 — 16 RUG-IV Category IV – Special Care High ADL = 2 — 16 RUG -IV ADL Score End Splits Category III – Extensive Services Signs of depression used as end splits: PHQ score ≥10 1 Category II – Rehabilitation 1. Tube Feeding Classification Requirement 4. Restorative Nursing Services 2. Selected Ulcer Treatments 3. Selected Skin Treatments 2 2 2 2 4 4 Category I – Rehabilitation Plus Extensive Services ADL = 2 — 16 RUG -IV ADL Score See Rehab Criteria (Category II) and Extensive Services Criteria (Category III) 3 1 score ≥10 Total RUG -IV ADL Score: 4