SNF Presumption- Conditions and care that result in required RUGs
Special Care High
Comatose and completely ADL dependent or ADL did not occur
Septicemia
DM and insulin shots all 7 days and insulin order changes on 2 or more days during the look back
Quadriplegia with ADL score >=5 (Bed Mobility, Transfers, Toileting and Eating)
COPD and SOB when lying flat
Fever and pneumonia or vomiting or weight loss or feeding tube
Parenteral/IV feedings
Respiratory Therapy for all 7 days (we do not have this)
Special Care Low
Cerebral palsy, or Multiple sclerosis, or Parkinson’s with ADL score >=5
Respiratory failure and oxygen while a resident
Feeding tube
Two or more stage 2 pressure ulcers with two or more selected skin treatments
One stage 2 pressure ulcer and one venous/arterial ulcer with two or more selected skin treatments
Foot infection, DM foot ulcer or other open lesion of foot with application of dressings to feet
Radiation treatment while a resident (at cancer center)
Dialysis treatment while a resident (at hemodialysis unit)
Clinically Complex
Pneumonia (active diagnosis, still taking antibiotics)
Hemiplegia/hemiparesis with ADL score >=5
Surgical wounds or open lesions with any selected skin treatment (only one needed)
Burns
Chemo, or oxygen or IV medications or transfusion while a resident
