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   RAI Manual Revisions   November, 2005

 

CH.

Sect.

Pg.

November 2005 Revision

NA

NA

Title Page

Revised date changed

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NA

Acknowledge-ments Page

Changed website address to read http://cms.hhs.gov/quality/mds20

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NA

Page V

Table of Contents – changed RUG-III 44 to 53

CH 6

NA

6-1 to 6-28

Replace Chapter 6 in its entirety, due to numerous changes and changes in pagination.

 Throughout chapter replaced ‘44’ with ‘53’, ‘seven’ with ‘eight’, ‘26’ with ‘35’ 

Added ‘Rehabilitation Plus Extensive Services’  when indicated

 

B

1-6

RAI Coordinator and Regional Office contacts updated

Changed website address to read http://cms.hhs.gov/quality/mds20

 

I

1-23

Replace the previous Section I (pages 1-27)

Change Matrix Version 4.6 (03/15/2005) to 4.7 (08/15/2005)

Change Data Specifications Version: 1.20 to 1.30                  

Change RUG-III Case Mix Classification, Version 5.12 (or 5.12b) to 5.20

RP=Resident Assessment Protocols, change MDS Data Specification Version from 1.01 to 1.30

QM=Quality Measures publicly reported in 11/2004 (15 QMs)

 

 

EIGHT MAJOR RUG-III CLASSIFICATION GROUPS

MAJOR RUG-III GROUP

CHARACTERISTICS ASSOCIATED WITH MAJOR RUG-III GROUP

Rehabilitation Plus Extensive Services

Residents receiving physical, speech or occupational therapy AND receiving IV feeding or medications, suctioning, tracheostomy care, or ventilator/respirator.

Rehabilitation

Residents receiving physical, speech or occupational therapy.

Extensive Services

Residents receiving complex clinical care or with complex clinical needs such as IV feeding or medications, suctioning, tracheostomy care, ventilator/respirator and comorbidities that make the resident eligible for other RUG categories.

Special Care

Residents receiving complex clinical care or with serious medical conditions such as multiple sclerosis, quadriplegia, cerebral palsy, respiratory therapy, ulcers, stage III or IV pressure ulcers, radiation, surgical wounds or open lesions, tube feeding and aphasia, fever with dehydration, pneumonia, vomiting, weight loss or tube feeding.

Clinically Complex

Residents receiving complex clinical care or with conditions requiring skilled nursing management and interventions for conditions and treatments such as burns, coma, septicemia, pneumonia, foot infections or wounds, internal bleeding, dehydration, tube feeding, oxygen, transfusions, hemiplegia, chemotherapy, dialysis, physician visits/order changes.

Impaired Cognition

Residents having cognitive impairment in decision-making, recall and short-term memory. (Score on MDS 2.0 cognitive performance scale >=3).

Behavior Problems

Residents displaying behavior such as wandering, verbally or physically abusive or socially inappropriate, or who experience hallucinations or delusions

Reduced Physical Function

Residents whose needs are primarily for activities of daily living and general supervision.

Full Text of Revisions from CMS:

November Update 2005

More information about maximizing MDS reimbursement can be found in the book

 The MDS Coordinator's Handbook

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