Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Trends in the Assignment of 
Resource Utilization Groups by 
Skilled Nursing Facilities 
JULY 2001 
OEI-02-01-00280  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them. This statutory mission is carried out through 
a nationwide program of audits, investigations, inspections, sanctions, and fraud alerts. The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General. It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public. 
The inspection reports provide findings and recommendations on the efficiency, vulnerability, 
and effectiveness of departmental programs. 
OEI's New York regional office prepared this report under the direction of John I. Molnar, 
Regional Inspector General, and Renee C. Dunn, Deputy Regional Inspector General. Principal 
OEI staff included: 
REGION  HEADQUARTERS

Jodi Nudelman, Project Leader  Tricia Davis, Program Specialist

Danielle Fletcher, Lead Analyst  Brian Richie, Director, Technical Support Staff

To obtain copies of this report, please call the New York Regional Office at (212) 264-2000. 
Reports are also available on the World Wide Web at our home page address: 
http://www.hhs.gov/oig/oei  E X E C U T I V E  S U M M A R Y  
PURPOSE 
To examine changes in the proportion of Medicare beneficiaries assigned to each 
Resource Utilization Group in light of recent legislative changes to the prospective 
payment system for skilled nursing facilities. 
BACKGROUND 
Congress mandated in Section 314 of the Benefits Improvement and Protection Act that 
the Office of Inspector General review the Medicare payment structure for services 
classified within the rehabilitation Resource Utilization Groups (RUGs) no later than 
October 1, 2001. In response, this inspection examines the trends in the proportion of 
Medicare residents assigned to each RUG to assess whether recent changes to the 
payment rates have created incentives for nursing facilities to admit certain patients. 
The Balanced Budget Act of 1997 changed reimbursement for skilled nursing facilities 
from a cost-based to a prospective payment system (PPS). Under the prospective 
payment system, skilled nursing facilities are required to assign residents to 1 of 44 
RUGs. In the Fall of 1999, Congress enacted the Balanced Budget Refinement Act 
(BBRA), which included a 4 percent across-the-board increase in payments to skilled 
nursing facilities for Fiscal Years 2001 and 2002 and a temporary 20 percent increase to 
15 RUGs for patient conditions considered medically complex. The changes went into 
effect on October 1, 2000. In 2000, Congress further adjusted the payment rates under 
the Benefits Improvement and Protection Act, which became effective on April 1, 2001. 
This inspection is based on an analysis of the Centers for Medicare and Medicaid 
Services National Claims History File. We analyzed the admission RUG code for all 
residents by quarter from January 1999 to January 2001. 
FINDINGS 
No major changes in RUG assignment since the implementation 
of PPS 
Virtually no change in the proportion of residents assigned to the 
rehabilitation RUGs There are seven RUG categories: special rehabilitation, 
extensive care, special care, clinically complex, cognitively impaired, behavior problems, 
and reduced physical functions. The proportion of Medicare residents assigned to the 
RUGs in the rehabilitation category has remained about the same since the 
implementation of PPS in January 1999. There have also been no large changes in the 
i
Trends in RUGs for SNFS   OEI-02-01-00280  proportion of Medicare residents assigned to any of the other categories during this time 
period. In the first quarter of 2001, about 78 percent of all Medicare residents were 
assigned to one of the rehabilitation RUGs at admission. 
Small shifts within the rehabilitation RUGs Shifts have occurred in the proportion 
of residents assigned to the RUGs within the rehabilitation category since the 
implementation of PPS in January 1999. Medicare residents who require therapy are 
coded into one of five sub-categories depending upon the amount of therapy they need. 
These sub-categories are: ultra high, very high, high, medium, and low. The proportion 
of Medicare residents assigned to the high and medium therapy sub-categories increased 
slightly, while those assigned to the ultra high, very high, and low therapy sub-categories 
decreased slightly since the implementation of PPS. 
The BBRA increased payment rates for three RUGs within the high and medium therapy 
sub-categories. The proportion of Medicare residents assigned to two of these RUGs 
increased slightly, while those assigned to the third RUG remained about the same since 
the implementation of PPS. At the same time, the proportion of residents in all of the 
RUGs in the ultra-high, very high, and low therapy sub-categories steadily decreased 
over the last 2 years. It is important to note that the trends in the proportion of residents 
assigned to all of these RUGs have not changed since the BBRA became effective. 
No changes in the other RUGs The BBRA increased payment for all RUGs in the 
extensive care, special care, and clinically complex categories by 20 percent. Our 
analysis shows minimal changes in the proportion of residents coded in each of the RUGs 
in these categories since the implementation of PPS. 
Beneficiary characteristics remain the same  We found no substantial changes in 
the characteristics of Medicare beneficiaries who were admitted to SNFs since the 
implementation of PPS. Specifically, beneficiaries age, sex, race, and reason for 
Medicare eligibility are the same in every quarter since January 1999. 
CONCLUSION 
While we identified small changes in the affected rehabilitation RUGs, it appears that 
these trends began prior to the BBRA. We will continue to monitor the trends in the 
proportion of Medicare residents assigned to each of the RUGs as new data become 
available. 
ii
Trends in RUGs for SNFS   OEI-02-01-00280  T A B L E   O F   C O N T E N T S  
PAGE

EXECUTIVE SUMMARY ...................................................... i

INTRODUCTION ............................................................. 1

FINDINGS 
No major changes in RUGs since PPS  ....................................... 5

CONCLUSION ............................................................... 8

APPENDICES 
A: List of RUGs ......................................................... 9

B: RUG Payment Rates .................................................. 10

C: Proportion of Medicare Residents in RUG Categories ........................ 11

D: Proportion of Medicare Residents in each RUG  ............................ 12

iii
Trends in RUGs for SNFS   OEI-02-01-00280  I N T R O D U C T I O N  
PURPOSE 
To examine changes in the proportion of Medicare beneficiaries assigned to each 
Resource Utilization Group in light of recent legislative changes to the prospective 
payment system for skilled nursing facilities. 
BACKGROUND 
Congress mandated in Section 314 of the Benefits Improvement and Protection Act 
(BIPA) that the Office of Inspector General (OIG) review the Medicare payment 
structure for services classified within the rehabilitation Resource Utilization Groups 
(RUGs) no later than October 1, 2001. In response, this inspection examines the trends 
in the proportion of residents assigned to each RUG to assess whether recent changes to 
the payment rates have created incentives for facilities to admit certain patients. This 
inspection is related to the OIG study entitled, Medicare Beneficiary Access to Skilled 
Nursing Facilities 2001, OEI-02-01-00160, which evaluates access to SNFs for Medicare 
beneficiaries based on interviews with hospital discharge planners and an analysis of 
Medicare data. 
Medicare Payments to SNFs 
Medicare Part A helps to pay for SNF care when a beneficiary meets certain conditions. 
These conditions include a requirement of daily skilled nursing or rehabilitation services, 
a prior three consecutive day stay in a hospital, admission to a SNF within a short period 
of time after leaving the hospital, treatment for the same condition that was treated in the 
hospital, and a medical professional certifying the need for daily skilled nursing or 
rehabilitative care. The number of SNF days provided under Medicare is limited to 100 
days per benefit period, with a co-payment required for days 21 through 100. After the 
Medicare 100 day SNF Part A benefit runs out, the Medicare Part B benefit continues to 
pay for physician services and other Part B covered services. 
In order to control escalating nursing home costs, the Balanced Budget Act of 1997 
changed SNF reimbursement from a cost-based to a prospective payment system. 
Beginning with the first cost reporting period after July 1, 1998, SNFs are paid through 
prospective, case-mix adjusted per diem payments that cover routine, ancillary, and 
capital-related costs, including most items and services for which payment was 
previously made under Medicare Part B. The per diem payment is based on Fiscal Year 
1995 Part A & B costs adjusted using the SNF market basket index, the case-mix from 
resident assessments, and geographical wage variations. The market basket index 
1
Trends in RUGs for SNFS   OEI-02-01-00280  represents an inflation factor. The case-mix index takes into account that SNF residents 
require different levels of care. 
To determine the case-mix, SNFs are required to classify residents into 1 of 44 Resource 
Utilization Groups (RUGs). (See Appendix A for a complete listing of the RUGs.) To 
do this, SNFs must fill out the Minimum Data Set 2.0 (MDS) assessment, a standardized 
set of clinical and functioning status measures. An interdisciplinary team from the 
nursing home completes the MDS for every resident by the 5th, 14th, 30th, 60th, and the 90th 
days of their stay. Prior to PPS, the MDS had been used exclusively for care planning. 
The RUGs are divided into seven major categories: special rehabilitation, extensive 
services, special care, clinically complex, impaired cognition, behavior problems, and 
reduced physical function. Each of the RUGs is associated with a payment rate that is 
based on a number of factors such as the need for therapy and the level of functioning 
measured in terms of the activities of daily living (ADL). Medicare typically reimburses 
SNFs for residents coded only in the first four categories. 
Residents requiring physical or occupational therapy are assigned to a RUG in the special 
rehabilitation category. There are five special rehabilitation sub-categories: ultra-high, 
very high, high, medium and low. Each resident is classified in a sub-category depending 
on the number of therapy minutes required as indicated on the MDS in the last seven 
days. Each resident is then assigned to a specific RUG within these sub-categories 
depending on the level of self-performance and support needed with four ADLs: eating, 
bed mobility, toileting, and transfers. The score on the MDS for these four ADLs places 
the resident into a specific RUG. For example, a resident who requires 500 minutes of 
therapy and scores a 12 on the MDS for the ADLs would be assigned to RVB. (See 
Table 1.) 
2
Trends in RUGs for SNFS   OEI-02-01-00280  Table 1 
Special Rehabilitation Category 
Sub-Category  Therapy Minutes  Score on the MDS 
Required in the Last  of Four ADLs for 
7 Days  each RUG 
Ultra-High  720 minutes  RUC= 16 to 18 
RUB= 9 to 15 
RUA= 4 to 8 
Very-High  500 minutes or more  RVC= 16 to 18 
RVB= 9 to 15 
RVA= 4 to 8 
High  325 minutes or more  RHC= 16 to 18 
RHB= 9 to 15 
RHA= 4 to 8 
Medium  150 minutes or more  RMC= 16 to 18 
RMB= 9 to 15 
RMA= 4 to 8 
Low  45 minutes or more  RLB= 14 to 18 
RLA= 4 to 13 
Recent Legislation 
Since the passage of the BBA 1997, Congress has made several changes to PPS. In the 
Fall of 1999, Congress enacted the Balanced Budget Refinement Act (BBRA) in 
response to providers concerns that reductions in payments were too severe. The BBRA 
included a 4 percent across-the-board increase in payments to SNFs for Fiscal Years 
2001 and 2002 and a temporary 20 percent increase to 15 RUGs for patient conditions 
considered medically complex. These include all the RUGs in the clinically complex, 
special care, and extensive care categories as well as three RUGs in the special 
rehabilitation category (RMB, RHC, and RMC). In addition, several costly non-therapy 
ancillary services, including certain ambulance services, prostheses, and chemotherapy 
drugs, are excluded from the prospective payment system and paid for separately. The 
BBRA changes went into effect on October 1, 2000. (See Appendix B for an example of 
the changes in the payment rates under BBRA.) 
In 2000, Congress further adjusted the payment rates under the Benefits Improvement 
and Protection Act (BIPA). The BIPA increased the inflation update to the full market 
basket in Fiscal Year 2001 and raised the nursing component of the RUGs by 16.6 
3
Trends in RUGs for SNFS   OEI-02-01-00280  percent in an effort to improve PPS nursing staff ratios. Additionally, the BBRA 20 
percent increase to the three rehabilitation RUGs was spread across all 14 special 
rehabilitation RUGs as a 6.7 percent increase. The other RUGs affected in the BBRA 
maintained the 20 percent increase. These changes went into effect on April 1, 2001. 
METHODOLOGY 
Using the Centers for Medicare and Medicaid Services (CMS) National Claims History 
File, we examined data for Medicare beneficiaries who were admitted to SNFs between 
January 1, 1999 and March 31, 2001. We reviewed the RUG code generated from the 
MDS assessment conducted at admission that is on the UB92 claim. We analyzed the 
proportion of Medicare beneficiaries in each of the 44 RUG codes and in each of the 7 
RUG categories by quarter beginning in January 1999. We specifically focused on 
changes in the special rehabilitation RUGs that may result from the BBRA legislation. 
Second, we examined select characteristics of the Medicare beneficiaries in our analysis. 
Specifically, we analyzed the CMS enrollment data including beneficiaries age, race, 
sex, and the reason for eligibility to assess whether changes in these characteristics are 
associated with trends in the RUGs. Note that another OIG inspection, Medicare 
Beneficiary Access to Skilled Nursing Facilities 2001, OEI-02-01-00160, addresses the 
clinical characteristics of beneficiaries admitted to SNFs. Included in that analysis is the 
proportion of Medicare beneficiaries discharged to SNFs and the length of hospital stays 
for these patients by key diagnosis related groups (DRGs). 
Limitations 
The changes to the payment rates legislated in the BIPA will not be implemented until 
April 1, 2001. This analysis is therefore limited to the changes SNFs make as they 
anticipate the reforms made in the BIPA legislation. 
The data in the most recent quarter, January to March 2001, are not as complete as the 
other data used in our analysis. These data may change based on additional and adjusted 
claims submitted over the next year. 
This inspection was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity an Efficiency. 
4
Trends in RUGs for SNFS   OEI-02-01-00280  F I N D I N G S
No major changes in RUG assignment since the implementation of
PPS 
Virtually no change in the proportion of residents assigned to the rehabilitation
RUGs
The proportion of Medicare residents assigned to RUGs in the rehabilitation category has
remained about the same since the implementation of PPS in January 1999.  There also
have been no large changes in the proportion of Medicare residents assigned to any of the
other RUG categories during this time period.  These categories include: extensive care,
special care, clinically complex, cognitively impaired, behavior problems, and reduced
physical functions.  (See Appendix C.)
In the first quarter of 2001, about 78 percent of all Medicare residents were assigned to
one of the rehabilitation RUGs at admission.  Another 13 percent were assigned to RUGs
in the extensive care category and 5 percent were in the special care category.  (See
Figure 1.)
Figure 1
Source: National Claims History File
5
Trends in RUGs for SNFS                                                                                                                                       OEI-02-01-00280 Small shifts within the rehabilitation RUGs
Shifts have occurred in the proportion of residents assigned to the RUGs within the
rehabilitation category since the implementation of PPS in January 1999.  Medicare
residents who require therapy are coded in one of five sub-categories in the rehabilitation
category depending upon the amount of therapy they need.  These sub-categories are:
ultra high, very high, high, medium, and low. 
The proportion of Medicare residents coded in the high and medium therapy sub-
categories increased slightly in every quarter since the implementation of PPS.  At the
same time, the proportion of Medicare residents in the ultra high, very high, and low sub-
categories decreased in almost every quarter since the implementation of PPS.  As shown
in Figure 2, the high and medium sub-categories increased from 53 percent to 61 percent
over the last 2 years, whereas the other three therapy sub-categories decreased from 23
percent to 17 percent during this time period.
Figure 2
Proportion of Medicare Residents in RUGs
Source: National Claims History File
6
Trends in RUGs for SNFS                                                                                                                                       OEI-02-01-00280 The Balanced Budget Refinement Act (BBRA) raised the payment rates for three RUGs 
within the high and medium therapy sub-categories: RHC, RMC, RMB. These changes 
may have created incentives for SNFs to put residents into these RUGs as opposed to 
other rehabilitation RUGs. 
Our analysis shows that the proportion of Medicare residents assigned in the three RUGs 
affected by the BBRA increased or remained about the same since the implementation of 
PPS in January 1999. Specifically, the proportion of residents coded in RHC increased 
from 15 to 19 percent, those coded in RMB rose from 8 to 9 percent, and those coded in 
RMC remained about the same at 5 percent from 1999 to 2001. The proportion of 
residents in the other RUGs in the high and medium therapy sub-categories that were not 
affected by the BBRA followed similar patterns in that they increased or remained stable. 
At the same time, the proportion of residents assigned to all the remaining RUGs in the 
ultra-high, very high, and low therapy sub-categories steadily decreased over the last 2 
years. It is important to note that the trends in the proportion of residents assigned to all 
of these RUGs have not changed since the BBRA became effective in October 2000. 
(See Appendix D.) 
No changes in the other RUGs 
The BBRA increased payment for each of the RUGs in the extensive care, special care, 
and clinically complex categories equally by 20 percent. In doing so, the law did not 
create incentives for SNFs to assign residents to one RUG as opposed to another. Our 
analysis shows minimal changes in the proportion of residents coded in each of the RUGs 
in these categories since the implementation of PPS. Specifically, the proportion of 
residents in each of these RUGs fluctuated by less than one percentage point in every 
quarter in the last 2 years. 
Beneficiary characteristics remain the same 
We found no substantial changes in the characteristics of Medicare beneficiaries who 
were admitted to SNFs since the implementation of PPS. Specifically, beneficiaries age, 
sex, race, and reason for Medicare eligibility are the same in every quarter since January 
1999. In the first quarter of 2001, the average age of SNF Medicare beneficiaries at 
admission was 80 years. About 66 percent of Medicare beneficiaries were female. 
Eighty-eight percent were white and nine percent were black. About 94 percent of 
beneficiaries were eligible for Medicare because of age without end stage renal disease. 
7
Trends in RUGs for SNFS   OEI-02-01-00280  C O N C L U S I O N  
While we identified small changes in the affected rehabilitation RUGs, it appears that 
these trends began prior to the BBRA. We will continue to monitor the trends in the 
proportion of Medicare residents assigned to each of the RUGs as new data become 
available. 
8
Trends in RUGs for SNFS   OEI-02-01-00280  APPENDIX A 
9
Trends in RUGs for SNFS   OEI-02-01-00280  APPENDIX B 
Comparison of RUG Rates for Urban Skilled Nursing Facilities 
RUG  Original  Revised BBRA 
Payment*  Payment** 
RUC  $384.21  $400.93 
RUB  $345.90  $360.90 
RUA  $327.28  $341.46 
RVC  $296.15  $309.12 
RVB  $286.30  $298.83 
RVA  $261.12  $272.52 
RHC  $271.53  $340.19 
RHB  $249.64  $260.61 
RHA  $228.84  $238.88

RMC  $267.34  $334.96 
RMB  $238.87  $299.27 
RMA  $224.64  $234.52 
RLB  $212.95  $222.39

RLA  $179.01  $186.93

SE3  $252.91  $317.02 
SE2  $218.97  $274.46 
SE1  $194.88  $244.26 
SSC  $190.50  $238.78 
SSB  $181.74  $227.80 
SSA  $177.36  $222.30 
CC2  $189.41  $237.41 
CC1  $175.18  $219.56 
CB2  $166.42  $208.58 
CB1  $158.75  $198.97 
CA2  $157.66  $197.60 
CA1  $148.90  $186.62 
*Published in the May 12, 1998 Federal Register 
** Calculated from the revised SNF payment rates released by the CMS on April 1, 2001 
http://www.hcfa.gov/medicare/snfppsuprate.htm 
***Highlighting indicates RUGs that were increased by the Balanced Budget Refinement Act 
10
Trends in RUGs for SNFS   OEI-02-01-00280  APPENDIX C 
The Proportion of Medicare Residents in Each
RUG Category at Admission by Quarter 
CY2000 
CY 1999  CY 2001  Difference 
RUG  QTR 1  QTR 2 QTR 3  QTR 4  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1   1999-2001
Rehabilitation  76.5  77.0  77.0  76.3  76.2  76.4  76.6  77.3  78.1  1.6 
Extensive  12.6  12.6  12.7  13.3  13.5  13.1  13.1  12.9  12.8  .2 
Care 
Special Care  5.6  5.4  5.4  5.3  5.2  5.3  5.2  4.9  4.7  -.9 
Clinically 3.8  3.5  3.4  3.4  3.4  3.4  3.3  3.1  2.9  -.9 
Complex 
Cognitively .3  .3  .3  .4  .4  .4  .4  .4  .4  .1 
Impaired 
Behavior  .04  .04  .1  .1  .1  .1  .1  .1  .1  0 
Problems 
Reduced  1.1  1.1  1.2  1.2  1.1  1.3  1.3  1.2  1.1  -.1 
Physical
Functions 
Total  421,912  412,927  406,346  421,990  476,749  430,072 416,336  392,319  374,529 
11
Trends in RUGs for SNFs   OEI-02-01-00280  The Proportion of Medicare Residents in Each APPENDIX D 
RUG at Admission by Quarter 
CY 1999  CY 2000  CY 2001  Difference 
RUG  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  1999-2001 
RUA  1.2  1.0  0.9  0.7  0.7  0.7  0.6  0.6  0.6  -0.6 
RUB  4.3  3.8  3.4  2.9  2.7  2.6  2.5  2.3  2.5  -1.8 
RUC  1.1  0.9  0.8  0.7  0.7  0.7  0.6  0.6  0.6  -0.5 
RVA  3.9  3.7  3.6  3.3  3.3  3.2  3.1  2.9  3.0  -0.9 
RVB  10.1  10.0  9.9  9.4  9.2  8.7  8.7  8.3  8.5  -1.6 
RVC  2.0  2.0  1.9  1.8  1.7  1.6  1.6  1.4  1.4  -0.6 
RHA  6.1  6.1  6.1  6.0  6.2  6.2  6.1  6.2  6.3  0.3 
RHB  15.8  16.6  16.9  17.3  17.3  17.3  17.4  17.8  18.1  2.3 
RHC  15.0  15.7  16.3  16.9  16.9  17.5  17.9  18.9  19.1  4.2 
RMA  3.4  3.3  3.4  3.3  3.4  3.5  3.4  3.4  3.3  0.0 
RMB 
8.2  8.3  8.3  8.4  8.5  8.9  9.1  9.4  9.1  0.9 
RMC  4.9  5.0  5.1  5.1  5.3  5.2  5.2  5.3  5.2  0.2 
RLA  0.3  0.3  0.2  0.2  0.2  0.2  0.2  0.2  0.2  -0.2 
RLB  0.2  0.2  0.1  0.1  0.1  0.1  0.1  0.1  0.1  -0.1 
*Highlighting indicates RUGs that were increased by the Balanced Budget Refinement Act 
Contd 
12
Trends in RUGs for SNFs   OEI-02-01-00280   CY 1999  CY 2000  CY 2001  Difference 
RUG  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  1999-2001 
SE1  0.4  0.4  0.4  0.5  0.4  0.5  0.4  0.4  0.4  0.0 
SE2  6.7  6.7  6.8  7.1  7.2  7.0  7.0  6.9  6.8  0.2 
SE3  5.5  5.5  5.4  5.8  5.9  5.6  5.7  5.5  5.6  0.0 
SSA  3.6  3.6  3.6  3.6  3.5  3.7  3.6  3.4  3.4  -0.3 
SSB  1.2  1.1  1.1  1.1  1.1  1.0  1.0  0.9  0.8  -0.3 
SSC  0.8  0.7  0.7  0.7  0.7  0.6  0.7  0.6  0.5  -0.3 
CA1  1.7  1.5  1.5  1.5  1.5  1.5  1.4  1.4  1.3  -0.4 
CB1  1.1  1.0  1.0  1.0  1.0  1.0  1.0  0.9  0.8  -0.2 
CC1  0.4  0.3  0.3  0.3  0.3  0.3  0.3  0.3  0.3  -0.1 
CA2  0.3  0.3  0.3  0.3  0.3  0.3  0.3  0.3  0.2  -0.1 
CB2  0.2  0.2  0.2  0.2  0.2  0.2  0.2  0.2  0.2  -0.1 
IA1  0.1  0.1  0.1  0.1  0.2  0.2  0.2  0.2  0.2  0.1 
IB1  0.2  0.2  0.2  0.2  0.2  0.2  0.2  0.2  0.2  0.0 
IA2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
IB2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
BA1  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
*Highlighting indicates RUGs that were increased by the Balanced Budget Refinement Act 
Contd 
13
Trends in RUGs for SNFs   OEI-02-01-00280   CY 1999  CY 2000  CY 2001  Difference 
RUG  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  QTR 2  QTR 3  QTR 4  QTR 1  1999-2001 
BB1  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
BA2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
BB2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
PA1  0.4  0.3  0.4  0.4  0.3  0.4  0.4  0.4  0.3  -0.1 
PB1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.0 
PC1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.0 
PD1  0.3  0.3  0.4  0.4  0.4  0.4  0.4  0.4  0.4  0.0 
PE1  0.1  0.1  0.2  0.2  0.2  0.2  0.2  0.2  0.1  0.0 
PA2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
PB2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
PC2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
PD2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
PE2  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0  0.0 
Other  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.1  0.0 
Total  421,912  412,927  406,346  421,990  476,749  430,072  416,336  392,319  374,529 
14
Trends in RUGs for SNFs   OEI-02-01-00280