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 10/1/2019. Here is a list of government resources related to the PDPM.

SNF PPS Final Rule FY2019

The Final Rule contains the regulations regarding the components of the PDPM system that will be implemented 10/1/2019.

SNF PPS Payment Model Research – PDPM Resources – general information page

SNF PDPM Technical Report

The SNF PDPM Technical Report discusses the additional analyses conducted, many in response to stakeholder feedback on the ANPRM, in development of the proposed PDPM.

SNF PDPM ICD-10 Diagnosis and Procedural Code Crosswalk

This SNF PDPM ICD-10 Diagnosis and Procedural Code Crosswalk assist to show how the PDPM would use ICD-10 diagnosis and procedural codes in order to classify SNF residents into one of ten PDPM Clinical Categories, which would then be used to further classify the resident for payment purposes under PDPM. These files provide a crosswalk between the ICD-10 diagnosis and procedure codes and the ten PDPM clinical categories.

SNF PDPM Classification Walkthrough, Version 2

SNF PDPM Grouper Tool, Version 3

SNF PDPM NTA Comorbidity Mapping, Version 2

The three files listed above help stakeholders in understanding the process by which SNF residents would be classified into PDPM payment groups. The first file provides a narrative step-by-step walkthrough that would allow 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 the proposed PDPM, and observe their impact on the resident’s PDPM classification. These files should be used in conjunction with the discussions found in the FY 2019 SNF PPS NPRM and accompanying files to better understand the process for resident classification under PDPM. The third file is a mapping, referenced in the narrative walkthrough file, between ICD-10-CM codes and the comorbidities used for resident classification under the NTA component.

SNF PDPM Provider Specific Impact Analysis

To assist stakeholders in understanding the potential impacts of the proposed PDPM, CMS provided this provider-specific impact analysis file, which details the estimated impact of the PDPM model discussed in the FY 2019 SNF PPS NPRM on Medicare Part A payments to each SNF in the country.

Minimum Data Set 3.0 Cognitive Function Scale

This report explains the retrospective cohort study conducted to develop the Cognitive Function Scale used as a basis for the cognitive scoring in the PDPM.

The Quality Reporting Program (QRP) Measure Calculations and Reporting User’s Manual, effective May 22, 2017, is a new manual as of spring 2017. It explains in detail the measure calculations for the Quality Measures that are a part of the QRP.

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