RAPID RUG GUIDE RUG-III, VERSION GROUPER Effective for Assessments With an ARD on or After 10/1/2013

Transcription

1 RAPID RUG GUIDE RUG-III, VERSION GROUPER Effective for Assessments With an ARD on or After 10/1/2013 Step 1: Calculation To calculate the score of Bed Mobility (G0110A), Transfer (G0110B) and Toilet Use (G0110I), use the following chart. The eating calculation will begin in Step #2. Column 1 = Column 2 = Score = 0 or 1 or 7 and any number = 1 2 and any number = 3 3, 4 and 0, 1 or 2 = 4 3, 4 or 8 and 3 or 8 = 5 Step 2: a) To complete the Eating Score calculation use the criteria below: K0510A, 1or 2 = checked Score = 3 OR K0510B, 1or 2 = checked + K0710A3 = 3 Score = 3 OR K0510B, 1or 2 = checked + K0710A3 = 2 + K0710B3 = 2 Score = 3 b) If no parenteral/iv (K0510A, 1or 2) or feeding tube (K0510B, 1or 2) return to G0110H to calculate the eating score using chart below: Extensive Services - s >= 7 Ext. Service Count RUG-III 1. Parenteral/IV (K0510A, 1 or 2) 4 or 5 SE3 2. Suctioning (O0100D, 1 or 2) 2 or 3 SE2 3. Tracheostomy Care (O0100E, 1 or 2) 0 or 1 SE1 4. Ventilator/Respirator (O0100F, 1 or 2) 5. IV Medication (O0100H, 1 or 2) Evaluate for Special Care, Clinically Complex, Impaired Cognition for the total Extensive Services Count Rehabilitation - s = 4-18 Score RUG-III Criteria # RAD 150 minutes or more (total) of therapy (O0400A,B,C) RAC At least 5 days of any combination RAB OR 4-9 RAA Criteria #2 45 minutes or more (total) of therapy (O0400A,B,C) At least 3 days of any combination At least 2 Programs, each administered for at least 15 minutes, each for 6 or more days (O0500A-J) Step 3: Column 1 = Score = 0 or 1 or 7 = 1 2 = 2 3, 4 or 8 = 3 The total Score range possibilities are 4 through 18 and include the sum for G0110A, G0110B, G0110I and the eating score. An score of 4 represents the most independent resident while a score of 18 represents the most dependent resident. Bed Mobility (G0110A ) = Transfer (G0110B ) = Toilet Use (G0110I ) = Eating = Total Score = Special Care - s >= 7 Score RUG-III 1. Cerebral Palsy (I4400) with s >= SSC 2. Quadriplegia (I5100) with s >= SSB 3. Multiple Sclerosis (I5200) with s >= SSA 4. Fever (J1550A) and at least one of the following: Pneumonia (I2000) Vomiting (J1550B) Dehydration (J1550C) Weight Loss (K0300) Feeding Tube (K0510B) * 5. Feeding tube (K0510B, 1 or 2)* and aphasia (I4300) * Feeding tube classification must include: (1) 51% or more calories (K0710A3) OR (2) 26-50% calories (K0710A3) and 501cc (K0710B3) or more per day enteral/parenteral intake 6. Two or more ulcers at any stage (M0300A, B1 and M1030) including 2 or more skin treatments** 7. Any stage 3 or 4 pressure ulcer (M0300C1, D1 and F1) including 2 or more skin treatments** ** 2 or more skin treatments: (1) Pressure relieving device chair/ bed (M1200A, B) (Count as one even if both provided) (2) Turning/repositioning program (M1200C) (3) Nutrition or hydration intervention to manage skin problems (M1200D) (4) Pressure ulcer care (M1200E) (5) Application of non-surgical dressings other than to feet (M1200G) (6) Application of ointment/medication other than to feet (M1200H) (Continued) Prepared by Myers and Stauffer LC DEDICATED TO GOVERNMENT HEALTH PROGRAMS

2 RAPID RUG GUIDE RUG-III, VERSION GROUPER Effective for Assessments With an ARD on or After 10/1/2013 Special Care s >= 7 (continued) 8. Open lesions (M1040D) including 1 or more skin treatment*** 9. Surgical Wounds (M1040E) including 1 or more skin treatment*** *** 1 or more skin treatment (1) Surgical wound care (M1200F) (2) Application of non-surgical dressings other than to feet (M1200G) (3) Application of ointment/medication other than to feet (M1200H) 10. Radiation Treatment (O0100B) 11. Respiratory Therapy (O0400D) provided for 7 days Clinically Complex - s = Coma (B0100) and self performance = 4 or 8 2. Pneumonia (I2000) 3. Septicemia (I2100) 4. Diabetes (I2900) and Injections (N0300) = 7 days and Physician Order Changes (O0700) >= 2 days 5. Hemiplegia/Hemiparesis (I4900) with s >= Dehydration (J1550C) Score Sad Mood RUG -III 7. Internal Bleeding (J1550D) Yes CC2 8. Feeding Tube (K0510B) * No CC1 9. Infection of the foot (M1040A) with application of Yes CB2 dressing (M1200I) No CB1 10. Diabetic foot ulcer/open lesions on the foot (M1040B, C) 4-11 Yes CA2 with application of dressing (M1200I) 4-11 No CA1 11. Burns (M1040F) 12. Chemotherapy (O0100A) 13. Oxygen therapy (O0100C) 14. Transfusions (O0100I) 15 Dialysis (O0100J) 16. Physician Visits (O0600)/Physician Order Changes (O0700) in the last 14 days Visits >= 1 day and Order Changes >= 4 days OR Visits >= 2 days and Order Changes >= 2 days PHQ-9 score (D0300) of 10 or greater is considered depressed OR PHQ-9-OV score (D0600) of 10 or greater is considered depressed Impaired Cognition ( BIMS) - s <=10 Score RN RUG-III 1. Repetition of three words (C0200) 6-10 IB2 2. Temporal Orientation (C0300A,B,C) 6-10 IB1 3. Recall (C0400A,B,C) 4-5 IA2 BIMs score (C0500) range IA1 Score of 9 or less = cognitively impaired Score of 10 or higher = cognitively intact Two or more Programs Prepared by Myers and Stauffer LC Impaired Cognition - s <=10 Score RN RUG-III 1. Coma (B0100) and self performance = 4 or 8 OR 6-10 IB2 2. Severely impaired decision making skills (C1000) OR 6-10 IB2 3. Two or more of the following indicators are present 4-5 IA2 B0700 > 0 problem making self understood 4-5 IA1 C0700 = 1 short term memory problem C1000 > 0 impaired decision-making skills and One or more of the following severe impairment indicators are present: B0700 >= 2 C1000 >= 2 Two or more Programs Behavior Problems - s <=10 Score RN RUG-III 1. Hallucinations (E0100A) 6-10 BB2 2. Delusions (E0100B) 6-10 BB1 3. Physical behavior symptoms (E0200A) 4 or more days 4-5 BA2 4. Verbal behavior symptoms (E0200B) 4 or more 4-5 BA1 5. Other behavior symptoms (E0200C) 4 or more days 6. Rejection of Care (E0800) 4 or more days 7. Wandering (E0900) 4 or more days Two or more Programs Reduced Physical Function - s = 4-18 Score RN RUG-III Any assessment that does not meet any of the prior criteria or PE2 had a match in Impaired Cognition or Behavior Problems with PE1 an score of 11 or more will classify in Reduced Physical PD2 Function PD1 Two or more Programs 9-10 PC PC1 6-8 PB2 6-8 PB1 4-5 PA2 4-5 PA1 Programs Current urinary toileting program (H0200C)**** Transfer (O0500E) Current bowel toileting program (H0500)**** Walking (O0500F)**** Range of motion (passive) (O0500A)**** Dressing and/or grooming (O0500G) Range of motion (active) (O0500B)**** Eating and/or swallowing (O0500H) Splint or brace assistance (O0500C) Amputation/prostheses care (O0500I) Bed mobility (O0500D)**** Communication (O0500J) ****Count as one service (H0200C and H0500; O0500A and B; O0500D and F) even if both are provided Program Criteria: Measurable objectives and interventions must be documented in the care plan and in the clinical record. Evidence of periodic evaluation by licensed nurse during observation period must be present in the clinical record. Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. These activities are carried out or supervised by members of the nursing staff. This category does not include exercise groups with more than four residents per supervising helper or caregiver. DEDICATED TO GOVERNMENT HEALTH PROGRAMS

3 RUG-III Classification Model Version 5.20, 34-Group Calculation of Score Effective for MDS 3.0 Assessments With an ARD Date on or After 10/1/2013 The (Activities of Daily Living) score calculation includes bed mobility, transfer, toilet use and eating. Below is the calculation process: STEP # 1 MDS 3.0 Items G0110A (1 & 2) G0110B (1 & 2) G0110I (1 & 2) G0110H (1) MDS Item Descriptions Bed mobility Transfer Toilet Use Eating Use the following chart to calculate the score for bed mobility, transfers, and toilet use. Record the associated scores to the right. The eating score will be calculated in Step #2. When Column 1 = And Column 2 = Then Score = (Record below) 0, 1 or 7 any number 1 2 any number 3 Bed mobility = 3 or 4 0, 1, or 2 4 Transfers = 3, 4, or 8 3 or 8 5 Toilet use = STEP # 2 MDS 3.0 Items K0510A, 1 or 2 K0510B, 1 or 2 K0710A3 K0710B3 MDS Item Descriptions Parenteral / IV Feeding Tube Total Calories During Entire 7 days Average Fluid Intake During Entire 7 days To complete the eating score calculation use the criteria below. Record the associated score to the right. a. If Parenteral / IV is checked, the eating Score = 3. Proceed to Step # 3. If not checked then; b. If Feeding Tube is checked AND total calories is 51% or more calories, the eating Score = 3. Proceed to Step # 3. If not then; c. If Feeding Tube is checked AND total calories is 26% to 50% calories AND average fluid intake is 501cc. or more fluid, the eating Score = 3. Proceed to Step # 3. If not then; d. When neither Parenteral / IV nor Feeding Tube (with appropriate intake) is checked, evaluate the chart below for eating self-performance. Proceed to Step # 3. When Column 1 (Only) = Then score = (Record below) 0, 1 or , 4, or 8 3 Eating = STEP # 3 The total combined score for bed mobility, transfer, toilet use and eating ranges between 4 through 18. A score of 4 represents an independent resident while a score of 18 represents a totally dependent resident. Total RUG-III Score =

4 RUG-III Classification Model Version 5.20, 34-Group Extensive Services Category I Effective For Assessments With an ARD on or After 10/1/2013 Extensive Services Clinical Groups and Services SE3 SE2 SE1 EXTENSIVE SERVICES (3 Categories) The resident must be receiving at least one of the following services and have an score of 7 or more: parenteral/iv, IV medication, suctioning, tracheostomy care, ventilator or respirator care. To determine the classification for the Extensive Services Category, an Extensive Service Count must be determined by the evaluation of the criteria for the Extensive Services category and by evaluating the criteria for Special Care, Clinically Complex and Impaired Cognition. The third character in the RUG-III classification (SE3) represents the designation for the Extensive Services count. SE3 Extensive Services (4 or 5 count) 7 18 SE2 Extensive Services (2 or 3 count) 7 18 SE1 Extensive Services (0 or 1 count)

5 Category I Extensive Services The classification groups in this category are based on various services provided. Use the following instructions to begin the calculation: STEP 1 Determine if the assessment is coded for at least one of the following treatments: MDS 3.0 Items K0510A 1 or 2 O0100D 1 or 2 O0100E 1 or 2 O0100F 1 or 2 O0100H 1 or 2 MDS Descriptions Parenteral / IV Suctioning Tracheostomy care Ventilator/respirator IV Medication A. If the assessment does not reflect receiving one of the above treatments, go to Category II, Rehabilitation. B. If at least one of the above treatments is coded but the Score is 6 or less, this assessment classifies as SSA. C. If at least one of the above treatments is coded and the score is 7 or greater, proceed to the Extensive Services Count. Go to Step #2. STEP 2 Extensive Services Count Determination: If Parenteral / IV is checked, include a count of 1 to the Extensive Services Count. If IV Medication is checked, include a count of 1 to the Extensive Services Count. Suctioning, Tracheostomy Care, and Ventilator/respirator contribute a count of 0 to the Extensive Services Count. Parenteral / IV is checked IV Medication is checked Suctioning is checked Tracheostomy care is checked Ventilator/respirator is checked = 1 count = 1 count = 0 count = 0 count = 0 count Extensive Services Count Possible range at this step is 0-2 STEP 3 To complete the Extensive Services Count: An Extensive Services Count is completed by evaluating the criteria for Special Care, Clinically Complex and Impaired Cognition. The final classification into SE1, SE2, or SE3 will be completed after all criteria have been evaluated. A. Go to Category III, Special Care. If the assessment meets one* or more of the Special Care criteria, assign a count of 1; (assign a count of 0, if no criteria are met in this category). B. Go to Category IV, Clinically Complex. If the assessment meets one* or more of the Clinically Complex criteria, assign a count of 1; (assign a count of 0, if no criteria are met in this category). C. Go to Category V, Impaired Cognition. If assessment meets one* or more of the Impaired Cognition criteria, assign a count of 1; (assign a count of 0, if no criteria are met in this category). *In STEP 3 even if the assessment meets more than one criterion in a category, it only receives an Extensive Services count of 1. 2

6 Category I Extensive Services STEP 4 To complete the Extensive Services Count evaluate the criteria in all four categories below and sum the count(s): Category I. Extensive Services Count - Extensive Service (0, 1, 2) Category III. Extensive Services Count - Special Care (0, 1) Category IV. Extensive Services Count - Clinically Complex (0, 1) Category V. Extensive Services Count - Impaired Cognition (0,1) Total Extensive Services Count (0 5) STEP 5 Determine the final Extensive Services classification using the Total Extensive Services Count: Score Extensive Count Extensive Services Case Mix Index SE SE SE Final Extensive Services Classification 3

7 RUG-III Classification 34 Group Model Rehabilitation Category II RAD Rehabilitation RAC 4-9 RAB RAA REHABILITATION (4 Categories) Rehabilitation is any combination of the disciplines of Speech, Occupational or Physical therapy. Services are also considered for the low intensity rehabilitation classification level. Services consist of providing passive and/or active range of motion, splint or brace assistance, and training and skill practice in bed mobility and/or walking, transfer, dressing or grooming, eating or swallowing, amputation/ prostheses care, communication, and urinary toileting or bowel toileting program. The third character of the RUG-III classification (RAD) indicates the level of the resident. RAD Rehabilitation RAC Rehabilitation RAB Rehabilitation RAA Rehabilitation 4-9

8 Category II Rehabilitation The classification groups in this category are based on any combination of licensed therapy meeting the criteria below. Use the following instructions: STEP 1 Total the therapy minutes for Speech, Occupational and Physical therapy: MDS 3.0 Items O0400A1, 2, 3 O0400A4 O0400B1, 2, 3 O0400B4 O0400C1, 2, 3 O0400C4 MDS Descriptions Speech therapy/minutes Speech therapy/days Occupational therapy/minutes Occupational therapy/days Physical therapy/minutes Physical therapy/days If the total combined number of therapy minutes is less than 45 minutes, the assessment does not classify in the Rehabilitation Category. Go to Category III, Special Care. STEP 2 If the total combined number of therapy minutes is greater than or equal to 45 minutes, consider the following criteria to complete the Rehabilitation classification: Criteria #1 Rehabilitation In the last 7 days were; 150 minutes or more combined total of therapy provided and At least 5 days of any combination of the 3 disciplines OR Criteria #2 Rehabilitation In the last 7 days were; 45 minutes or more combined total of therapy provided and At least 3 days of any combination of the 3 disciplines and 2 or more Services* received each for at least 15 minutes, each administered for 6 or more days, including current urinary toileting or bowel toileting program Services: MDS 3.0 Items MDS Descriptions H0200C ** Current urinary toileting program H0500 ** Current bowel toileting program O0500A** Passive ROM O0500B** Active ROM O0500C Splint or brace assistance O0500D** Bed mobility O0500E Transfer O0500F** Walking O0500G Dressing and/or grooming O0500H Eating and/or swallowing O0500I Amputation/prosthesis care O0500J Communication **(Count as one service (H0200C & H0500; O0500A & B; O0500D & F) even if both are provided) Total Services Provided 5

9 Category II Rehabilitation Restorative nursing program criteria: Measurable objectives and interventions must be documented in the care plan and in the clinical record. Evidence of evaluation by licensed nurse during the observation period must be present in the clinical record. Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. These activities are carried out or supervised by members of the nursing staff. This category does not include groups with more than four residents per supervising helper or caregiver. STEP 3 If the assessment meets one or both of the above criteria, record the appropriate Rehabilitation classification: Case Mix Rehabilitation Score Index RAD RAC RAB RAA 1.06 Final Rehabilitation Classification 6

10 RUG-III Classification 34 Group Model Special Care Category III SSC Special Care SSB 7-14 SSA SPECIAL CARE (3 Categories) At least one of the following conditions must be present: CP, MS, quadriplegia (each must have an score of >=10), fever, feeding tube, ulcers, open lesions, surgical wounds, radiation treatment, respiratory therapy, skin treatments, and other secondary elements. A resident who has one of the conditions listed in Extensive Services, but has an score of 6 or less would classify as Special Care (SSA). This category is also used to determine the Extensive Services count for any resident who classifies in the Extensive Services Category with an of 7 or more. The third character of the RUG-III classification (SSC) identifies the level of the resident. SSC Special Care SSB Special Care SSA Special Care

11 Category III Special Care The classification groups in this category are based on certain resident conditions. Note that certain conditions require special considerations. Use the following instructions: STEP 1 Determine if the assessment is coded for at least one of the following conditions: MDS 3.0 Items MDS Descriptions I4400 Cerebral palsy, with an score >=10 I5100 Quadriplegia, with an score >=10 I5200 Multiple sclerosis, with an score>=10 J1550A I2000 J1550B J1550C K or 2 K0510B 1 or 2 K0510B 1 or 2 and I4300 M0300A M0300B1 M1030 Fever and at least one of the following; Pneumonia Vomiting Dehydration Weight loss Feeding tube* Feeding tube* and Aphasia Number of Stage I pressure ulcers Number of Stage II pressure ulcers Number of venous and arterial ulcers 2 or more Stage I, II or venous/arterial ulcers with 2 or more skin treatments** M0300C1 One Stage III pressure ulcer with 2 or more skin treatments** M0300D1 One Stage IV pressure ulcer with 2 or more skin treatments** M0300F1 One Unstageable-slough and/or eschar pressure ulcer with 2 or more skin treatments** M1040D Open lesions with 1 or more skin treatment*** M1040E Surgical wounds with 1 or more skin treatment*** O0100B 1 or 2 Radiation treatment O0400D 2 Respiratory therapy provided for 7 days *Feeding tube items must include either: MDS 3.0 Items MDS Descriptions (1) K0710A3 51% or more calories entire 7 days OR (2) K0710A3 K0710B3 26% to 50% calories and average fluid intake is 501 cc. or more per day during entire 7 days **2 or more Skin Treatments: MDS 3.0 Items MDS Descriptions M1200A# Pressure relieving device/chair M1200B# Pressure relieving device/bed M1200C Turning/repositioning program M1200D Nutrition or hydration intervention to manage skin problems M1200E Pressure ulcer care M1200G Application of nonsurgical dressings (not to feet) M1200H Application of ointments/medications (not to feet) # (Count as one treatment even if both provided) 8

12 Category III Special Care ***1 or more Skin Treatment: MDS 3.0 Items MDS Descriptions M1200F Surgical wound care M1200G Application of nonsurgical dressings (not to feet) M1200H Application of ointments/medications (not to feet) A. To continue the scoring for the Extensive Services Category, evaluate the criteria for Special Care and determine the count by adding a score of 0 for no criteria match or a score of 1 for one or more criteria matches: Extensive Services Count Special Care (0, 1) B. If the assessment does not meet one of the above Special Care criteria, go to Category IV, Clinically Complex. C. If the assessment meets one or more of the criteria in the Special Care Category and the Score is 6 or less, the assessment classifies in the Clinically Complex Category (CA). To complete the Clinically Complex classification, go to Category IV, Clinically Complex, Step #2, to determine the presence (CA2) or absence (CA1) of mood symptoms. D. If neither B nor C above applies, classify the assessment by proceeding to Step # 2. STEP 2 If the Score is 7 or more and the assessment meets one or more criteria, record the appropriate Special Care classification based on the score: Case Mix Special Care Score Index SSC SSB SSA 1.25 Final Special Care Classification 9

13 RUG-III Classification 34 Group Model Clinically Complex Category IV Yes CC Sad Mood No CC1 Clinically Complex Sad Mood Sad Mood Yes Yes CB2 No CA2 CB1 No CA1 CLINICALLY COMPLEX (6 Categories) This category is classified by one of the following: coma, diabetes, hemiplegia, pneumonia, septicemia, dehydration, internal bleeding, feeding tube, burns, infection of foot, chemotherapy, dialysis, oxygen therapy, transfusions, physician visits, physician orders, and other secondary elements. A resident who has one of the conditions listed in Special Care, but has an score of 6 or less would classify as Clinically Complex (CA). This category is also used to determine the Extensive Services count for any resident who classifies in the Extensive Services Category with an of 7 or more. Once the Clinically Complex criterion is met, the resident is assessed for mood symptoms for final classification. The second character of the RUG-III class (CC2) identifies the level of the resident; the third character of the RUG-III class (CC2) identifies the presence (2) or absence (1) of mood symptoms. CC2 Clinically Complex / Mood Symptoms CC1 Clinically Complex CB2 Clinically Complex / Mood Symptoms CB1 Clinically Complex CA2 Clinically Complex / Mood Symptoms 4-11 CA1 Clinically Complex

14 Category IV Clinically Complex The classification groups in this category are based on certain resident conditions. Note that certain conditions require special considerations. Use the following instructions: STEP 1 Determine if the assessment is coded for at least one of the following conditions: MDS 3.0 Items B0100 I2000 I2100 I2900 N0300 O0700 MDS Descriptions Coma and completely dependent for Self-Performance (G0110A, G0110B, G0110H, G0110I = 4 or 8) Pneumonia Septicemia Diabetes mellitus and Injection = 7 days and Physician Order Changes >= 2 days I4900 Hemiplegia/hemiparesis with an score >=10 J1550C Dehydration J1550D Internal bleeding K0510B 1 or 2 Feeding tube* M1040A, M1200I Infection of the foot with application of dressings M1040B, M1200I M1040C, M1200I Diabetic foot ulcer with application of dressings Open lesions on the foot with application of dressings M1040F Burns O0100A 1 or 2 Chemotherapy O0100C 1 or 2 Oxygen therapy O0100I 1 or 2 Transfusions O0100J 1 or 2 Dialysis O0600, O0700 Physician Examinations/Physician Order Changes in the last 14 days: Examinations >= 1 day and Order Changes >= 4 days OR Examinations >= 2 days and Order Changes >= 2 days *Feeding tube items must include either: MDS 3.0 Items MDS Descriptions (1) K0710A3 51% or more calories entire 7 days OR (2) K0710A3 K0710B3 26% to 50% calories and average fluid intake is 501 cc. or more per day during the entire 7 days A. To continue the scoring for the Extensive Services Category, evaluate the criteria for Clinically Complex and determine the count by adding a score of 0 for no criteria match or a score of 1 for one or more criteria matches: Extensive Services Count - Clinically Complex (0, 1) B. If the assessment does not meet one of the above criteria, go to Category V, Impaired Cognition. C. If there is a match, proceed to Step # 2 to evaluate for mood symptoms. 11

15 Category IV Clinically Complex STEP 2 Signs of mood symptoms are used as a third level split for the Clinically Complex Category as follows: Criteria #1 MDS 3.0 Items D0200A2 D0200B2 D0200C2 D0200D2 D0200E2 D0200F2 D0200G2 D0200H2 D0200I2 For residents that are interviewable, complete resident interview (PHQ-9) MDS Definitions Little interest or pleasure in doing things Feeling down, depressed, or hopeless Trouble falling or staying asleep, or sleeping too much Feeling tired or having little energy Poor appetite or overeating Feeling bad about yourself-or that you are a failure or have let yourself or family down Trouble concentrating on things, such as reading the newspaper or watching TV Moving or speaking so slowly that other people could have noticed. Or the oppositebeing so fidgety or restless that you have been moving around a lot more than usual Thoughts that you would be better off dead, or of hurting yourself in some way Once completed, a PHQ score is calculated by summing the values in the symptom frequency column. The score is considered valid if no more than two items are incomplete. If the total score at D0300 is 10 or greater, the resident is considered depressed for the RUG system. Criteria #2 MDS 3.0 Items D0500A2 D0500B2 D0500C2 D0500D2 D0500E2 D0500F2 D0500G2 D0500H2 D0500I2 D0500J2 For residents that are NOT interviewable, complete staff assessment (PHQ-9-OV) MDS Definitions Little interest or pleasure in doing things Feeling or appearing down, depressed, or hopeless Trouble falling or staying asleep, or sleeping too much Feeling tired or having little energy Poor appetite or overeating Indicating that s/he feels bad about self, is a failure, or has let self or family down Trouble concentrating on things, such as reading the newspaper or watching TV Moving or speaking so slowly that other people could have noticed. Or the oppositebeing so fidgety or restless that s/he has been moving around a lot more than usual States that life isn t worth living, wishes for death, or attempts to harm self Being short tempered, easily annoyed Once completed, sum the values in the symptom frequency column. The score is considered valid if no more than two items are incomplete. If the score at D0600 is 10 or greater, the resident is considered depressed for the RUG system. STEP 3 Record the appropriate Clinically Complex classification based on both the Score and the total severity score at D0300 or D0600: Score Mood Symptoms Clinically Complex Case Mix Index Yes CC No CC Yes CB No CB Yes CA No CA Final Clinically Complex Classification 12

16 RUG-III Classification 34 Group Model Impaired Cognition Category V Impaired Cognition IB2 IA2 IB1 IA1 A resident must have an score of 10 or lower. IMPAIRED COGNITION (4 Categories) Classification is determined by whether the resident categorizes as cognitively impaired based on the BIMS or Cognitive Performance Score (CPS). Services and current urinary toileting or bowel toileting programs are secondary level elements measured to further classify a resident. This is the final category used to determine the Extensive Services count for any resident who classifies in the Extensive Services Category with an of 7 or more. The second character of the RUG-III classification (IB2) indicates the level, and the third character (IB2) indicates the number of Services received. IB2 Impaired Cognition / Services (2 or more services) 6-10 IB1 Impaired Cognition / Services (0 or 1 service) 6-10 IA2 Impaired Cognition / Services (2 or more services) 4-5 IA1 Impaired Cognition / Services (0 or 1 service)

17 Category V Impaired Cognition The classification groups in this category are based on certain resident conditions. Note that certain conditions require special considerations. Use the following instructions: STEP 1 The assessment s total score must be 10 or less. If the score is greater than 10, go to Category VII, Reduced Physical Function: STEP 2 All residents capable of any communication should be asked (interviewed) to provide information regarding what they consider to be the most important facets of their lives. Begin with criteria #1: Criteria #1 Resident interview for mental status If all BIMS (Brief Interview for Mental Status) items are completed, then a BIMS score is calculated: If one or more BIMS items are missing, then a BIMS score is not calculated. Proceed to Criteria 2. A resident with a BIMS score less than or equal to 9 is considered cognitively impaired for the RUG system. A resident with a BIMS score of 10 or greater is not considered to be cognitively impaired for the RUG system. MDS 3.0 Items MDS Descriptions C0200 Repetition of three words C0300A-C Temporal Orientation C0400A-C Recall C0500 BIMS score 5 Score <=9 is cognitively impaired for the RUG system Score >=10 is cognitively intact for the RUG system Criteria #2 Staff assessment for mental status Determine if the assessment meets at least one of the Impaired Cognition conditions: MDS 3.0 Items MDS Descriptions B0100 Comatose B0700 Makes self understood C0700 Short term memory problem C1000 Cognitive skills for daily decision making A. B0100 Coma and completely dependent for Self-Performance, if not then; B. C1000 Severely impaired daily decision making (C1000 = 3) If not then; C. B0700, C0700, C1000 These three items are assessed with none being blank or unknown: Two or more of the following impairment indicators are present: B0700 > 0 Problem making self understood C0700 = 1 Short term memory problem C1000 > 0 Cognitive skills for daily decision making and One or more of the following severe impairment indicators are present: B0700 >= 2 Severe problem making self understood C1000 >= 2 Severely impaired decision making skills 14

18 Category V Impaired Cognition STEP 3 Completion of the Extensive Services classification, if applicable, or the Impaired Cognition classification, if applicable: A. To complete the count for the Extensive Services Category, continue the Extensive Services Count by evaluating the criteria for Impaired Cognition by adding a count of 0 for no criteria match or a count of 1 for one or more criteria matches: Extensive Services Count - Impaired Cognition (0,1) This concludes the Extensive Services Count evaluation. Score Extensive Count Extensive Services Case Mix Index SE SE SE B. If the assessment does not meet one of the above Impaired Cognition criteria, go to Category VI, Behavior Problems. C. If there is a BIMS score <=9 in criteria 1 or a match in criteria 2, proceed to Step # 4. STEP 4 Count the number of Services* received each for at least 15 minutes, each administered for 6 or more days and including any current urinary toileting or bowel toileting program. Record the total count below: Services: MDS 3.0 Items MDS Descriptions H0200C ** Urinary toileting program H0500** Bowel toileting program O0500A** Passive ROM O0500B** Active ROM O0500C Splint or brace assistance O0500D** Bed mobility O0500E Transfer O0500F** Walking O0500G Dressing and/or grooming O0500H Eating and/or swallowing O0500I Amputation/prostheses care O0500J Communication **(Count as one service (H0200C & H0500; O0500A & B; O0500D & F) even if both are provided) Total Services Provided Restorative nursing program criteria: Measurable objectives and interventions must be documented in the care plan and in the clinical record. Evidence of evaluation by licensed nurse during the observation period must be present in the clinical record. Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. These activities are carried out or supervised by members of the nursing staff. This category does not include groups with more than four residents per supervising helper or caregiver. 15

19 Category V Impaired Cognition STEP 5 Record the appropriate Impaired Cognition classification by using the total Score and the Restorative Nursing Services Count: Score Services Count Impaired Cognition Case Mix Index or more services IB or 1 service IB or more services IA or 1 service IA Final Impaired Cognition Classification 16

20 RUG-III Classification 34 Group Model Behavior Problems Category VI Behavior Problems BB2 BA2 BB1 BA1 A resident must have an score of 10 or lower. BEHAVIOR PROBLEMS (4 Categories) This classification is determined by resident exhibiting behavioral problems, such as wandering, verbal behavioral symptoms, physical behavioral symptoms, other behavioral symptoms, rejection of care, and/or potential indicators of psychosis i.e., delusions or hallucinations. Services and urinary toileting or bowel toileting programs are the secondary level elements measured to further classify a resident. The second letter of the RUG-III classification (BB2) identifies the level of the resident; the third character (BB2) identifies the number of Services provided. BB2 Behavior Problems / Services (2 or more services) 6-10 BB1 Behavior Problems / Services (0 or 1 service) 6-10 BA2 Behavior Problems / Services (2 or more services) 4-5 BA1 Behavior Problems / Services (0 or 1 service)

21 Category VI Behavior Problems The classification groups in this category are based on certain resident conditions. Note that certain conditions require specific frequency levels. Use the following instructions: STEP 1 The assessment s total Score must be 10 or less. If the score is greater than 10, go to Category VII, Reduced Physical Function: STEP 2 At least one of the following conditions must be met: MDS 3.0 Items MDS Descriptions E0100A Hallucinations E0100B Delusions E0200A Physical behavioral symptoms (frequency level 2 or 3) E0200B Verbal behavioral symptoms (frequency level 2 or 3) E0200C Other behavioral symptoms (frequency level 2 or 3) E0800 Rejection of care (frequency level 2 or 3) E0900 Wandering (frequency level 2 or 3) STEP 3 If the assessment does not meet one of the above Behavior Problems criteria, go to Category VII, Reduced Physical Function: STEP 4 If at least one of the conditions is met in step 2 then proceed to the determination of the restorative nursing count. Count the number of Services* received each for at least 15 minutes, each administered for 6 or more days and including any current urinary toileting or bowel toileting program. Record the total count below: Services: MDS 3.0 Items MDS Descriptions H0200C ** Urinary toileting program H0500** Bowel toileting program O0500A** Passive ROM O0500B** Active ROM O0500C Splint or brace assistance O0500D** Bed mobility O0500E Transfer O0500F** Walking O0500G Dressing and/or grooming O0500H Eating and/or swallowing O0500I Amputation/prostheses care O0500J Communication **(Count as one service (H0200C & H0500; O0500A & B; O0500D & F) even if both are provided) Total Services Provided 18

22 Category VI Behavior Problems Restorative nursing program criteria: Measurable objectives and interventions must be documented in the care plan and in the clinical record. Evidence of evaluation by licensed nurse during the observation period must be present in the clinical record. Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. These activities are carried out or supervised by members of the nursing staff. This category does not include groups with more than four residents per supervising helper or caregiver. STEP 5 Record the appropriate Behavior Problem classification by using the total Score and the Restorative Nursing Services Count: Score Services Count Behavior Problems Case Mix Index or more services BB or 1 service BB or more services BA or 1 service BA Final Behavior Problems Classification 19

23 RUG-III Classification 34 Group Model Reduced Physical Function Category VII PE2 PE1 Reduced Physical Function PD2 PC2 PB2 PA2 PD1 PC1 PB1 PA1 REDUCED PHYSICAL FUNCTION (10 Categories) Residents who do not meet the conditions for any other category are placed in this category. Services and current urinary toileting or bowel toileting programs are secondary level elements measured to further classify a resident. Assessments classifying in Impaired Cognition or Behavior Problems with and > 10 classify here. The second character (PE2 of RUG-III classification identifies the level of the resident; the third character (PE2) identifies the number of Services provided. PE2 Physical Function / Services (2 or more services) PE1 Physical Function / Services (0 or 1 service) PD2 Physical Function / Services (2 or more services) PD1 Physical Function / Services (0 or 1 service) PC2 Physical Function / Services (2 or more services) 9-10 PC1 Physical Function / Services (0 or 1 service) 9-10 PB2 Physical Function / Services (2 or more services) 6-8 PB1 Physical Function / Services (0 or 1 service) 6-8 PA2 Physical Function / Services (2 or more services) 4-5 PA1 Physical Function / Services (0 or 1 service) 4-5 BC1 Unable to classify due to delinquency 20

24 Category VII Reduced Physical Function The classification groups in this category are based on the Score and Services Count. Use the following instructions: STEP 1 Assessments that do not meet the conditions of any of the previous categories or those that meet the criteria for the Impaired Cognition or Behavior Problems Categories but have an Score greater than 10, classify in this category: STEP 2 Count the number of Services* received each for at least 15 minutes, each administered for 6 or more days and including any current urinary toileting or bowel toileting program. Record the total count below: Services: MDS 3.0 Items MDS Descriptions H0200C ** Urinary toileting program H0500** Bowel toileting program O0500A** Passive ROM O0500B** Active ROM O0500C Splint or brace assistance O0500D** Bed mobility O0500E Transfer O0500F** Walking O0500G Dressing and/or grooming O0500H Eating and/or swallowing O0500I Amputation/prosthesis care O0500J Communication **(Count as one service (H0200C & H0500; O0500A & B; O0500D & F) even if both are provided) Total Services Provided Restorative nursing program criteria: Measurable objectives and interventions must be documented in the care plan and in the clinical record. Evidence of evaluation by licensed nurse during the observation period must be present in the clinical record. Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. These activities are carried out or supervised by members of the nursing staff. This category does not include groups with more than four residents per supervising helper or caregiver. 21

25 Category VII Reduced Physical Function STEP 3 Record the appropriate Reduced Physical Function classification by using the Score and the Restorative Nursing Services Count: Score Services Count Reduced Physical Case Mix Index or more services PE or 1 service PE or more services PD or 1 service PD or more services PC or 1 service PC or more services PB or 1 service PB or more services PA or 1 service PA Final Reduced Physical Function Classification 22

26 Virginia RUG 34 Grouper CMI List Hierarchy Case Mix Weights RUG CMI RUG CMI RAD 1.66 SE RAC 1.31 SE RAB 1.24 RAD 1.66 RAA 1.07 SE SE SSC 1.44 SE CC SE SSB 1.33 SSC 1.44 RAC 1.31 SSB 1.33 SSA 1.28 SSA 1.28 CC CC RAB 1.24 CC CB CB RAA 1.07 CB CB CA CA CA PE IB PE IB CA IA PD IA PD BB IB BB BB BA IB BA PC PE BB PE PC PD IA PD BA PC IA PC PB PB PB PB PA PA BA PA PA Prepared by Judy Wilhide Brandt

27 MDS Assessments Extensive Services 7-18 Clinical Groups & Services SE3 SE2 SE1 SE SE SE RAD RAD 1.68 Rehabilitation RAC RAB RAC 1.41 RAB 1.28 RAA RAA 1.06 Special Care SSC 7-14 SSB SSA SSC 1.40 SSB 1.29 SSA 1.25 Clinically Complex Sad Mood Sad Mood Sad Mood Yes Yes Yes CC2 No CB2 No CA2 CC1 CB1 CC CC CB CB CA No CA1 CA Impaired Cognition IB2 IA2 IB1 IB IB IA IA1 IA Behavior Problems BB2 BA2 BB1 BB BB BA BA1 BA PE2 PE1 PE PE Reduced Physical Functions PD2 PC2 PB2 PA2 PD1 PC1 PB1 PA1 PD PD PC PC PB PB PA PA