December 2011

Information Bulletin 11-07
NH-157
BC-59

Case Mix Review - RUGIV

Purpose:

The purpose of this informational bulletin is to inform providers that Case Mix Classifications for all residents residing in Medicaid-certified nursing and boarding care homes will be computed from the RUG IV (Resource Utilization Group), 48-group model beginning on January 1, 2012. The RUG IV, 48 group model will replace the current RUG III, 34 group model.

Background:

The Centers for Medicare and Medicaid Services (CMS) sponsored a staff time and resource study (STRIVE) in 2006 and 2007 in multiple nursing facilities in the United States. The results of this study were used to assist in the revision of Medicare case mix classifications. CMS also developed a case mix model, known as RUG IV, 48-group model, for states such as Minnesota who use the Minimum Data Set for state Medicaid case mix. The 2011 Minnesota State Legislature revised Minnesota Case Mix Statutes directing that Minnesota Case Mix Classifications be computed using the RUG IV, 48-group model beginning on January 1, 2012.

Transition Process:

All residents in Medicaid-certified nursing and boarding care homes will receive notices of their RUG-IV classifications on or about December 14, 2011. These notices will be made available to facilities in the same location that case mix classification notices are posted. Facility staff will print the notices and distribute them to residents and/or their representatives in the same manner that they distribute all case mix classification notices.

The case mix review program has prepared several resources to assist facilities and consumers in the transition and implementation of RUG IV:

  1. The Case Mix Review Program has prepared a fact sheet for facilities about the transition to RUG IV. It is available here: (link to fact sheet http://www.health.state.mn.us/divs/fpc/112911transitionsheet.pdf).

  2. Power point slides developed for the provider teleconference held on November 29, 2011, are available here: (link to slides http://www.health.state.mn.us/divs/fpc/112911pptslides.pdf).

  3. Consumer fact sheets about the RUG IV case mix classifications will be available at the Case Mix Review website (link to website http://www.health.state.mn.us/divs/fpc/profinfo/cms/casemix.html).
Updated Tuesday, November 29, 2011 at 03:19PM