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If services provided in SNF, residents remain in RUG domain (unless they have IV meds, IV feeding, or suctioning).

Affects residents in High Rehab classes with Extensive Services and in Extensive Services.

CMS also found that services in hospital did not predict resource use in SNF.

CMS found services often not provided in SNF.

IV meds, Ventilator/respirator, Tracheostomy, Suctioning in last 14 days.

Elimination of hospital “look back” periods.

ADL splits for Rehab + Extensive Services.

At least one therapy continued through last day of Part A stay.

Therapy started during last 4 days of Part A stay, including weekends.

ARD on Start of Therapy OMRA is on last day of Part A.ARD on or before 8th day of Part A stay.5-day or readmit/return assessment completed.Assessment is a Start of Therapy OMRA assessment.Divide total therapy minutes (previous slide) by number of days of therapy = Ave.If 25% limit applies, then (#1 + #2)*1.33 for adjusted therapy minutes.All minutes in group therapy, subject to limit of 25% of total therapy minutes.One-half of minutes of concurrent therapy.Limit will be 2 residents per therapist.If you contract for therapy, you may need to revise your contract.Check each resident’s actual therapy minutes against the estimate in section T.GAO found that one fourth of residents did not receive the amounts of therapy estimated in section T.Only therapy actually provided will count.Therapy Rates Therapy rates will go up, but. New Rates for Selected RUGs RUGs III RUGs IV Extensive Services Most domains have changes in qualifiers.Shifting of some services to different RUGs.

New domain-Special Care split into two.New short-stay therapy payment calculation.Higher indices for nursing lower for therapy.System to be budget neutral for Medicare.Major shift of $ from therapy to nursing care.AAHSA calculator estimates Medicare revenue.

Identify which residents move to a new RUG class and which do not.

Understand the principal changes in RUGs IV.

(Nb: toys not included).REVISED Medicare RUGs IV Changes Aging Services of Minnesota District Meetings January 2010 Watch your children rediscover their creativity and imagination on their new and unique play rug. We to capture your children's attention while also encouraging them to incorporate their expensive toys that would otherwise be forgotten.

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Anyone who grew up with a tiny garage full of diecast cars must remember those plush playmats featuring roads, parking lots, and parks.