49782 Federal Register/Vol. 72, No. 167/Wednesday, August 29, 2007/Rules and Regulations

EmptyCell

Table 2A: Case-Mix Adjustment Variables and Scores EmptyCell Episode number within sequence of adjacent episodes 1 or 2 1 or 2 3+ 3+ EmptyCell Therapy visits 0 - 13 14+ 0 - 13 14+ EmptyCell EQUATION : 1 2 3 4 CLINICAL DIMENSION 1 Primary or Other Diagnosis = Blindness/Low Vision 3 3 3 3 2 Primary or Other Diagnosis = Blood disorders . 2 5 EmptyCell EmptyCell 3 Primary or Other Diagnosis = Cancer, selected benign neoplasms 4 7 3 10 4 Primary Diagnosis = Diabetes 5 12 1 8 5 Other Diagnosis = Diabetes 2 4 1 4 6 Primary or Other Diagnosis = Dysphagia AND Primary or Other Diagnosis = Neuro 3 - Stroke 2 2 EmptyCell 6 7 Primary or Other Diagnosis = Dysphagia AND MO250 (Therapy at home) =3 (Enteral) EmptyCell 6 EmptyCell EmptyCell

Federal Register/Vol. 72, No. 167/Wednesday, August 29, 2007/Rules and Regulations 49783

EmptyCell

Table 2A: Case-Mix Adjustment Variables and Scores EmptyCell Episode number within sequence of adjacent episodes 1 or 2 1 or 2 3+ 3+ EmptyCell Therapy visits 0 - 13 14+ 0 - 13 14+ EmptyCell EQUATION : 1 2 3 4 8 Primary or Other Diagnosis = Gastrointestinal disorders 2 6 1 4 9 Primary or Other Diagnosis = Gastrointestinal disorders AND M0550 (ostomy) = 1 or 2 3 EmptyCell EmptyCell EmptyCell 10 Primary or Other Diagnosis = Gastrointestinal disorders AND Primary or Other Diagnosis = Neuro 1 - Brain disorders and paralysis, OR Neuro 2 - Peripheral neurological disorders, OR Neuro 3 - Stroke, OR Neuro 4 - Multiple Sclerosis EmptyCell EmptyCell 2 EmptyCell 11 Primary or Other Diagnosis = Heart Disease OR Hypertension 3 7 1 8 12 Primary Diagnosis = Neuro 1 - Brain disorders and paralysis 3 8 5 8 13 Primary or Other Diagnosis = Neuro 1 - Brain disorders and paralysis AND M0680 (Toileting) = 2 or more 3 10 3 10 14 Primary or Other Diagnosis = Neuro 1 - Brain disorders and paralysis OR Neuro 2 - Peripheral neurological disorders AND M0650 or M0660 (Dressing upper or lower body)= 1, 2,or 3 2 4 2 2 15 Primary or Other Diagnosis = Neuro 3 - Stroke EmptyCell 1 EmptyCell EmptyCell

49784 Federal Register/Vol. 72, No. 167/Wednesday, August 29, 2007/Rules and Regulations

EmptyCell

Table 2A: Case-Mix Adjustment Variables and Scores EmptyCell Episode number within sequence of adjacent episodes 1 or 2 1 or 2 3+ 3+ EmptyCell Therapy visits 0 - 13 14+ 0 - 13 14+ EmptyCell EQUATION : 1 2 3 4 16 Primary or Other Diagnosis = Neuro 3 - Stroke AND M0650 or M0660 (Dressing upper or lower body)= 1, 2,or 3 1 3 2 8 17 Primary or Other Diagnosis = Neuro 3 - Stroke AND M0700 (Ambulation) = 3 or more 1 5 EmptyCell EmptyCell 18 Primary or Other Diagnosis = Neuro 4 - Multiple Sclerosis AND AT LEAST ONE OF THE FOLLOWING: M0670 (bathing) = 2 or more OR M0680(Toileting)= 2 or more OR M0690(Transferring) = 2 or more OR M0700(Ambulation). 3 or more 3 3 12 18 19 Primary or Other Diagnosis = Ortho 1 - Leg Disorders or Gait Disorders AND M0460 (most problematic pressure ulcer stage)= 1, 2, 3 or 4 2 EmptyCell EmptyCell EmptyCell 20 Primary or Other Diagnosis= Ortho 1 - Leg OR Ortho 2 - Other orthopedic disorders AND MO250(Therapy at home) = 1 (IV/Infusion) or 2 (Parenteral) 5 5 EmptyCell EmptyCell

Federal Register/Vol. 72, No. 167/Wednesday, August 29, 2007/Rules and Regulations 49785

EmptyCell

Table 2A: Case-Mix Adjustment Variables and Scores EmptyCell Episode number within sequence of adjacent episodes 1 or 2 1 or 2 3+ 3+ EmptyCell Therapy visits 0 - 13 14+ 0 - 13 14+ EmptyCell EQUATION : 1 2 3 4 21 Primary or Other Diagnosis = Psych 1 - Affective and other psychoses, depression 3 5 2 5 22 Primary or Other Diagnosis = Psych 2 - Degenerative and other organic psychiatric disorders 1 2 EmptyCell 2 23 Primary or Other Diagnosis = Pulmonary disorders 1 5 1 5 24 Primary or Other Diagnosis = Pulmonary disorders AND M0700 (Ambulation) = 1 or more 1 EmptyCell EmptyCell EmptyCell 25 Primary Diagnosis = Skin 1 - Traumatic wounds, burns, and post-operative complications 10 20 8 20 26 Other Diagnosis = Skin 1 - Traumatic wounds, burns, post operative complications 6 6 4 4 27 Primary or Other Diagnosis = Skin 1 -Traumatic wounds, burns, and post-operative complications OR Skin 2 - Ulcers and other skin conditions AND MO250 (Therapy at home) = 1 (IV/Infusion) or 2 (Parenteral) 2 EmptyCell 2 EmptyCell 28 Primary or Other Diagnosis = Skin 2 - Ulcers and other skin conditions 6 12 5 12 29 Primary or Other Diagnosis = Tracheostomy 4 4 4 EmptyCell 30 Primary or Other Diagnosis = Urostomy/Cystostomy 6 23 4 23

49786 Federal Register/Vol. 72, No. 167/Wednesday, August 29, 2007/Rules and Regulations

EmptyCell

Table 2A: Case-Mix Adjustment Variables and Scores EmptyCell Episode number within sequence of adjacent episodes 1 or 2 1 or 2 3+ 3+ EmptyCell Therapy visits 0 - 13 14+ 0 - 13 14+ EmptyCell EQUATION : 1 2 3 4 31 MO250 (Therapy at home) = 1 (IV/Infusion) or 2 (Parenteral) 8 15 5 12 32 MO250 (Therapy at home) = 3 (Enteral) 4 12 EmptyCell 12 33 M0390(Vision) = 1 or more 1 EmptyCell EmptyCell 1 34 M0420 (Pain)= 2 or 3 1 EmptyCell EmptyCell EmptyCell 35 M0450 = Two or more pressure ulcers at stage 3 or 4 3 3 5 5 36 M0460 (Most problematic pressure ulcer stage) = 1 or 2 5 11 5 11 37 M0460(Most problematic pressure ulcer stage) - 3 or 4 16 26 12 23 38 M0476 (Stasis ulcer status) = 2 8 8 8 8 39 M0476 (Stasis ulcer status) = 3 11 11 11 11 40 M0488 (Surgical wound status) = 2 EmptyCell 2 3 EmptyCell 41 M0488 (Surgical wound status) = 3 4 4 4 4 42 M0490 (Dyspnea) = 2, 3, or 4 2 2 EmptyCell EmptyCell 43 M0540 (Bowel Incontinence) = 2 to 5 1 2 1 EmptyCell 44 M0550(Ostomy) = 1 or 2 5 9 3 9 45 M0800 (Injectable Drug Use) = 0, 1, or 2 1 1 2 4 FUNCTIONAL DIMENSION 46 M0650 or M0660 (Dressing upper or lower body)= 1, 2, or 3 2 4 2 2 47 M0670 (Bathing) = 2 or more 3 3 6 6 48 M0680 (Toileting) = 2 or more 2 3 2 EmptyCell 49 M0690 (Transferring) = 2 or more EmptyCell 2 EmptyCell EmptyCell 50 M0700 (Ambulation) = 1 or 2 1 EmptyCell 1 EmptyCell 51 M0700 (Ambulation) = 3 or more 3 4 4 5