How is SNF PPS case-mix determined beyond DRGs?

• A. Severity of Illness (SOI) index
• B. Discharge disposition
• C. DRG weight
• D. Resource Utilization Groups (RUGs)

Answer: (D)

In SNF payments, the variation in resident needs is captured by Resource Utilization Groups (RUGs). This system uses data from the resident’s MDS assessments to estimate the level of daily resources a resident requires, especially therapy minutes and nursing care. Residents are assigned to a RUG category based on their documented therapy hours, nursing care needs, non-therapy ancillary services, and overall clinical complexity. Each RUG category corresponds to a specific daily payment rate, so the case mix is driven by expected resource use rather than DRG weights.

Discharge disposition isn’t used to classify case mix, and DRG weights apply to hospital inpatient payments rather than SNFs. Severity of Illness is a hospital DRG nuance, not the SNF payment driver, and DRG weight itself isn’t used in SNF PPS.