RUG-III Version 5.12

The Grouper Program (M3PI) for RUGs 5.12 has been recently updated to version 5.12B. This minor change will only affect facilities that use the manual M3PI Calculator Screen of the Grouper program to perform RUGs classification. Facilities that use the Groupers's MDS file update process, use proprietary MDS software, use the CMS provided RAVEN software, or use the CMS provided 5.12 DLL should be unaffected and no software or other changes should be required.

If you use the manual M3PI Calculator Screen of the 5.12 Grouper program for RUGs classification, please download and use the new 5.12B Grouper version. The new 5.12B Grouper allows manual entry (on the M3PI Calculator Screen) of the new Medicare reasons for assessment (item AA8b codes "7" and "8") implemented with the 1/30/98 Revision to MDS 2.0. While Version 5.12 of the Grouper did not accommodate these new codes on the M3PI Calculator Screen, this version of the Grouper did handle these new codes appropriately when updating RUGs in an MDS file. There are no other substantive changes with Version 5.12B of the Grouper, with all classification logic, methods, Case Mix Indices, etc. remaining unchanged from Version 5.12 of the Grouper.

This version is for an amended RUG-III 1997 Update appropriate for use in the Medicare Prospective Payment System (PPS) to be implemented nationally beginning on July 1, 1998. Both 44 and 34 group models are provided. The 44 group model of this version will be used in the Medicare PPS in all States. Each Medicare facility in the nation will begin using the Medicare PPS and RUG-III Version 5.12 with the start of the facility's new fiscal year on or after July 1, 1998. The 34 group model of Version 5.12 may also be used for Medicaid payment purposes in some States. The 44 group model is not recommended for Medicaid payment purposes.

There were two changes to the RUG-III classification logic with Version 5.12 (from Version 5.11). These changes are (1) MDS item J5c, "end-stage" disease, has been dropped as a qualifier for the Clinically Complex groups and (2) the ADL break point between the 34 group model RAA and RAB rehabilitation groups has been modified to an upper value of 9 for RAA and a lower value of 10 for RAB.


Page Last Modified:
02/27/2012 05:19 PM