Skilled Nursing Resource Utilization Group Classifications

The Resource Utilization Group Skilled Nursing Standard (RUG, or currently RUG-IV) classification system has eight major classification categories: Rehabilitation Plus Extensive Services, Rehabilitation, Extensive Services, Special Care High, Special Care Low, Clinically Complex, Behavioral Symptoms and Cognitive Performance Problems, and Reduced Physical Function (see Table 1). The categories, except for Extensive Services, are further divided by the intensity of the resident’s ADL needs. The Special Care High, Special Care Low, and Clinically Complex categories are also divided by the presence of depression. Finally, the Behavioral Symptoms and Cognitive Performance Problems and the Reduced Physical Function categories are divided by the provision of restorative nursing services.

A calculation worksheet was developed in order to provide clinical staff with a better understanding of how the RUG-IV classification system works. The worksheet translates the standard software code into plain language to assist staff in understanding the logic behind the classification system. A copy of the calculation worksheet for the RUG-IV classification system for nursing homes can be found at the end of this section.

Characteristics Associated With Major RUG-IV Category
 See CMS’s RAI Version 3.0 Manual CH 6: Medicare SNF PPS CHAPTER 6: MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM (SNF PPS)

Example of RUG Scores for a Post Acute / Sub Acute / SNF Population

Rehabilitation Plus Extensive Services

Residents satisfying all of the following three conditions:
1.     Having a minimum activity of daily living (ADL) dependency score of 2 or more.
2.     Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident.
3.     While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation.

Rehabilitation

Special Care High

Residents receiving physical therapy, occupational therapy, and/or speech- language pathology services while a resident.

Residents satisfying the following two conditions:

Extensive Services

Residents satisfying the following two conditions:

1. Having a minimum ADL dependency score of 2 or more.

2. While a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation.

Having a minimum ADL dependency score of 2 or more.

Receiving complex clinical care or have serious medical conditions involving any one of the following:

—  comatose,

—  septicemia,

—  diabetes with insulin injections and insulin order changes,

—  quadriplegia with a higher minimum ADL dependence criterion (ADL score of 5 or more),

—  chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat,

—  fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement,

—  parenteral/IV feeding, or

—  respiratory therapy.

Special Care Low

Residents satisfying the following two conditions:

1. Having a minimum ADL dependency score of 2 or more.

2. Receiving complex clinical care or have serious medical conditions involving any of the following:

—  cerebral palsy with ADL dependency score of 5 or more,

—  multiple sclerosis with ADL dependency score of 5 or more,

—  Parkinson’s disease with ADL dependency score of 5 or more,

—  respiratory failure and oxygen therapy while a resident,

—  tube feeding meeting intake requirement,

—  ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers or Stage II pressure ulcers,

—  ulcer treatment with any Stage III or IV pressure ulcer,

—  foot infections or wounds with application of dressing,

—  radiation therapy while a resident, or

—  dialysis while a resident.

Clinically Complex

Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions or treatments involving any of the following:

pneumonia,

hemiplegia with ADL dependency score of 5 or more,

surgical wounds or open lesions with treatment,

burns,

chemotherapy while a resident,

oxygen therapy while a resident,

IV medications while a resident, or

transfusions while a resident.

Behavioral Symptoms and Cognitive Performance

Residents satisfying the following two conditions:

1. Having a maximum ADL dependency score of 5 or less.

2. Having behavioral or cognitive performance symptoms, involving any of the following:

—  difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9),

—  difficulty in making self understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3),

—  hallucinations,

—  delusions,

—  physical behavioral symptoms toward others,

—  verbal behavioral symptoms toward others,

—  other behavioral symptoms,

—  rejection of care, or

—  wandering.

Reduced Physical Function

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

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