D.2 - VANHE120 RUG-III CLASSIFICATION HIERARCHY.docx

D.2 SAMPLE RUG-III Classification & Hierarchy Assumes average VA resident in CNH is rated at Clinically Complex. If this is not the case, VACO will re-stratify rates.

Per Diem rate for Clinically Complex = 1. Other rates are percentage increase/ decrease from the Clinically Complex average.

Additional flexibility in rate structure will require consultation with G&EC. VA rates cannot be less than Medicaid rates for a given level of care.

Example: Clinically Complex PD at CNH is $200. In this case a Special Care Per Diem = $222.40.

Major RUG-III Group

Characteristics Associated with Major RUG-III Group

Rehabilitation Plus Extensive Services 88.1%

RUX, RUL

RVX, RVL

RHX, RHL

RMX, RML

RLX

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

Rehabilitation 56.2%

RUA, RUB

RUC, RVA

RVB, RVC

RHA, RHB

RHC, RMA

RMB, RMC

RLA, RLB

Residents receiving physical, speech or occupational therapy

Extensive Services 35.2%

SE1, SE2

SE3

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

Special Care 11.2%

SSA, SSB

SSC

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 0.0%

CA1, CA2

CB1, CB2

CC1, CC2

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 -20.2%

IA1, IA2

IB2

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

Behavior Problems -21.6%

BA1, BA2

BB1, BB2

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

Reduced Physical Function -18.1%

PA1, PA2

PB1, PB2

PC1, PC2

PD1, PD2

PE1, PE2

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