Therapy Component Rug

Under rug iv the number of pt ot and slp therapy treatment minutes are combined for a total number of treatment minutes that is used to classify a given patient into a given therapy rug under pdpm patient characteristics will be used to predict the therapy costs associated with a given patient rather than rely on service use. 8 tep focused on the therapy component was held in february 2015 nursing index rug session 1 introductions and project overview therapy base rate therapy index rug or rehab non rehab payment rug non case mix therapy. Under rug iv you have two case mix categories nursing which includes non therapy ancillary services and therapy which includes physical occupational and speech therapy.

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Of the resident and a case mix adjusted non therapy ancillary component.

Therapy component rug.

Therapy rugs are used to bill over 90 of part a days pdpm moves away from intensity driven model of payment to characteristic need driven model of payment. The nursing component is case mix adjusted for all rugs. Pdpm component per diem and rug iv rate reference table 4 15 19 update pdpm pt variable per diem payment rate table urban pt case mix group fy 2019 federal per diem rate urban day 1 20 day 21 27 day 28 34 day 35 41 day 42 48 day 49 55 day 56 62 day 63 69 day 70 76 day 77 83 day 84 90 day 91 97 day 98 100. Rug non case mix therapy component non case mix component nursing base rate nta nursing 43 57.

And a non case mix adjusted component reflecting the costs of room and board linens and administrative services. A therapy component reflecting the amount of therapy services provided or expected to be provided. Adjust the nursing components of state medicaid payment systems one exception. Cms provides nursing and therapy weights that are used along with other component factors to establish person level per diem.

Since 1998 snfs have been paid under the resource utilization group prospective payment system rug iv pps. Under rug iv therapy payments are based on the number of days and minutes of services under a single component. The therapy component is case mix adjusted for. Texas medicaid adjusts the rug 34 relative risk.

Above is a picture of what life is like under rug iv vs. Both pt and ot components will have individual cmis for payment whether therapy is provided or not since therapy days and minutes do not play a role in payment calculations under pdpm as it does in the current rug iv pps payment system. Rug iv includes six therapy payment levels. Resource utilization group rugs system.

Lynda jennings otr tota mcc 2019 11 3 18 4 key elements of pdpm. One of the basic abcs of pdpm will be the change in case mix components. Utilizes the same nursing classification structure as rug iv except there are some modifications. The resident s rug was either a therapy rug or non therapy nursing rug.

An initial set of rugs developed primarily to. Ultra high very high high medium low and therapy non case mix.

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