CMS Planning Nov. 9 Conference Call to Discuss RUG-IV

If you still have questions about RUG-IV, CMS has answers. The agency has announced plans for a toll-free provider conference call that will take place from 2 - 3:30 p.m. (EDT) on November 9.

This will be the fourth call that CMS has hosted to provide details on the signifcant changes happening with RUG-IV. After the formal presentation, callers will have a chance to ask CMS subject matter experts questions.

The RUG-IV SNF PPS case mix system was put into place on an interim basis effective October 1.

To learn more and register for the call, click here. Registration closes on November 8, or when all available spots have been filled.

House Repeals RUG-IV Delay

The House has passed a bill that eliminates the one-year delay of the RUG-IV case-mix classification system. This means it would take effect on October 1, 2010, the same day as MDS 3.0. The Senate is expected to pass the bill.

The action earned applause from both the AHCA and Alliance for Quality Nursing Home Care.

To learn more, click here.

CMS Hosting Wednesday Conference Call on MDS 3.0, RUG-IV

This Wednesday, June 23, CMS will be hosting a conference call to discuss MDS 3.0 and RUG-IV. The call is open to providers across the nation and will begin at 1:30 p.m. EDT.

According to CMS, the call will cover the following:

• Key aspects of RUG-IV (which is being implemented on an interim basis on October 1, 2010)
• Coding procedures, with an emphasis on the appropriate "look-back" periods that need to be used when coding MDS 3.0
• How staff should separately report individual, concurrent and group therapy for accurate payment
• How changes to the ADL coding requirements will impact the assignment of MDS 3.0 records to a RUG-IV group

To learn more and register for the conference call, click here. If you are unable to dial in to the call, two additional provider calls are being scheduled for August 2010.

Could We See RUG-IV This Year After All?

We heard back in March that RUG-IV's implementation date was being pushed back to October 1, 2011, but a bill making its way into Congress would restore the original implementation date of October 1, 2010.

The bill, known as the American Jobs and Closing Tax Loopholes Act, would also extend a temporary increase to the federal medical assistance percentage (FMAP) through June 30, 2011 and delay the Medicare physician pay cut for three years.

Congress is expected to vote on the bill this week.

To download a summary of the bill, click here.

RUG-IV Now on the Back Burner Until 2011

The new healthcare reform package will push back the RUG-IV classification system's implementation until October 1, 2011.

RUG-IV, or Resource Utilization Group, Version Four, is a revised case-mix classification model. Medicare uses the case-mix classification system to assign nursing home residents to categories based on their medical conditions and the resources that are needed to care for them. Each category is tied to a specific Medicare payment rate.

A few of the changes that will be included in RUG-IV include:

• An increased number of RUG categories (from 53 to 66)
• The Special Care category will be split into Special Care High and Special Care Low
• The Impaired Cognition and Behavior categories will be combined to form one category: Behavioral Symptoms and Cognitive Performance
• Revisions to calculations of therapy minutes

To learn more about the changes that will come with RUG-IV, click here.

Healthcare reform will also retain the Medicare market basket, delay a "productivity adjustment" to provider reimbursements and extend the Medicare Part B therapy caps exceptions process through December 31 of 2010. It also establishes payment bundling pilot programs, requires disclosure of nursing home ownership, increases civil monetary penalties against nursing homes, establishes an independent Medicare payment advisory board and implements the CLASS (Community Living Assistance Services and Supports) Act.