Ask the legal expert: Legal concerns for MDS and RUG-IV

Share this article:
Attorney John Durso, Ungaretti & Harris LLP
Attorney John Durso, Ungaretti & Harris LLP

Question: Do you foresee any legal concerns or cautions brought about by the implementation of the new MDS 3.0 and RUG-IV payment systems?

Yes and no. Version 3.0 of the Minimum Data Set (MDS 3.0) instrument and the corresponding case-mix classification model, Resource Utilization Group (RUG IV), which were implemented Oct. 1, make significant changes to long-term care reimbursement. These changes, however, relate mainly to the financial, operational, and clinical practices of long-term care providers and raise few, if any, unique “legal” concerns.

Additionally, RUG-IV virtually eliminates the “extensive rehabilitation services” category of service and re-weights the lower rehabilitation services. Despite this change, the overall number of RUG categories will increase from 53 to 66. RUG-IV also reduces certain look-back periods so that providers may only count, in RUG calculations, services rendered after SNF placement. This reduced look-back period will decrease the number of residents in higher-paying RUG categories.

Successful facilities will develop clinical compliance programs and refocus the efforts of staff to meet Centers for Medicare & Medicaid Services goals.

One initial step providers should take is to evaluate the change in service categories based on the type of residents they admit and the needs of those specific residents. A self-evaluation of that sort will allow management to narrowly tailor policies to the requirements of the MDS 3.0-RUG-IV framework. These sorts of strategic approaches will allow long-term care facilities to improve the quality of resident care and accurately document the care they provide to ensure they receive proper reimbursement for their services.

Please send your legal questions to John Durso at ltcnews@mcknights.com

Share this article:

More in News

Long-term care continues to lead in deal volume and value: PwC report

Long-term care continues to lead in deal volume ...

Long-term care bucked healthcare industry trends with strong merger and acquisition activity in the second quarter of 2014, according to newly released data from professional services firm PricewaterhouseCoopers.

Empowering nurse practitioners could reduce hospitalizations from SNFs, study finds

Granting more authority to nurse practitioners is associated with reduced hospitalization of skilled nursing facility residents, according to recently published findings.

Pioneer ACO drops out of program, despite reductions in skilled nursing utilization

A California healthcare system has become the latest dropout from the Pioneer Accountable Care Organization program, despite reducing skilled nursing facility utilization and improving its readmission rates. Sharp HealthCare announced its decision in a quarterly financial statement released Tuesday.