Government Source Documents

On this page, you'll find the core government regulatory documents with which every long-term care nurse must be familiar. Click on the titles below to find a brief description of the regulation and the issues most relevant to the long-term care field.

AANAC experts synthesize and break down updates on complex CMS regulations and requirements in the Long-Term Care Leader enewsletter. Search for past articles or by topic in the Resource Library.

In the August 2018 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule, CMS announced that the RUGs-IV Case Mix System will be replaced by the PDPM effective Oct. 1, 2019, for fee-for-service Medicare Part A residents. Here is a list of government resources related to the PDPM.

SNF PPS Final Rule FY2019

The Final Rule and its correction notice contain the regulations regarding the components of the PDPM system that will be implemented on Oct. 1, 2019.

SNF PPS Payment Model Research – PDPM Resources – general information page on how the model was developed, including the SNF PDPM Technical Report, which discusses the additional analyses conducted, many in response to stakeholder feedback on the ANPRM, in developing the PDPM.

PDPM Home Page

CMS has developed this home page as the go-to resource for all things PDPM, including fact sheets, FAQs, training presentations, and educational tools.

ICD-10 Diagnosis Code to PDPM Clinical Category Crosswalk

This SNF PDPM ICD-10 clinical category mapping tool helps show how the PDPM uses ICD-10 diagnosis codes to classify SNF residents into one of ten PDPM primary clinical categories, which are then used to further classify the resident for payment purposes under the PT, OT, and SLP components of PDPM. These files provide a crosswalk between the ICD-10 diagnosis codes and the ten PDPM clinical categories.

SNF PDPM Classification Walkthrough

SNF PDPM Grouper Logic (SAS)

SNF PDPM NTA Comorbidity Mapping

The three files listed above help stakeholders in understanding the process by which SNF residents are classified into PDPM payment groups. The first file provides a narrative step-by-step walkthrough that allows stakeholders to manually determine a resident’s PDPM classification based on the data from an MDS assessment. The second file is a spreadsheet-based grouper tool which can be used to test certain combinations of MDS items used to classify residents under PDPM, and observe their impact on the resident’s PDPM classification. The third file is a mapping between ICD-10-CM codes and the comorbidities used for resident classification under the NTA component.

Fact Sheets

PDPM Frequently Asked Questions

PDPM FAQS

Dec. 11, 2018 SNF PPS: New Patient-Driven Payment Model Call

Try AANAC Today!

Not an AANAC member? Join us risk free for 30 days to access articles, expert advice, and FAQs to help you in your role.

Start Your Trial Membership