Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment System (PDPM) is scheduled to begin Oct. 1, 2019, and AANAC is here to help!

The Centers for Medicare & Medicaid Services released the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, which solidified their plans to implement the PDPM. The PDPM is set to replace the RUG-IV case-mix classification model that has been the hallmark of SNF PPS for years. This new payment system will be unlike anything SNFs have seen before! You and your staff have a lot to do to get ready for the PDPM, and AANAC will be with you the entire way.  Visit this page frequently to get tools, education, and resources to help you lead your team readiness.

  • PDPM and ICD-10-CM Quick Reference Guide

    By AANAC - October 18, 2018
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  • Are You Using the Right FY 2019 Federal RUG Rates?

    By Caralyn Davis - October 16, 2018

    On Oct. 3, CMS published a correction notice for the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule to address a series of technical errors. “Chief among those” were corrections to the total case-mix-adjusted federal per-diem RUG-IV payment rates that were necessary due to errors in copying values, said officials with the Centers for Medicare & Medicaid Services (CMS) at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).

     

    Specifically, CMS has issued updated versions of both Table 6, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Urban,” and Table 7, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Rural,” to correct the Total Rate column. For example, those tables in the FY 2019 SNF PPS final rule show federal RUX payment as $832.89 for urban SNFs and $852.10 for rural SNFs. The correction notice changes the federal RUX rate to $832.61 urban and $851.84 rural.

     

    Other FY 2019-specific corrections include the following:

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  • Five Mistakes Often Made Selecting ICD-10-CM Codes in the SNF

    By Jessie McGill, RN, RAC-MT - October 16, 2018
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  • PDPM At-a-Glance Tool

    By AANAC - October 03, 2018
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  • FY 2019 SNF PPS Final Rule PLUS Correction, Updated Wage Index Tables (10/18)

    By CMS - October 01, 2018
    Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program. 

    Correction Notice SUMMARY: This document corrects technical errors in the final rule that appeared in the August 8, 2018 Federal Register (83 FR 39162) entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program.” DATES: The corrections in this document are effective October 1, 2018 .

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  • Goodbye RUG-IV: PDPM Will Implement On Oct. 1, 2019

    By Caralyn Davis, Staff Writer - August 02, 2018
    On July 31, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, ushering in a new payment era for traditional fee-for-service Medicare Part A that will be unlike anything SNFs have seen before. The Patient-Driven Payment Model (PDPM) will go into effect on Oct. 1, 2019 (i.e., starting with FY 2020), replacing the RUG-IV case-mix classification model that has been the hallmark of SNF PPS for years.
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  • AANAC Responds to FY 2019 SNF PPS Proposed Rule: Is Now the Time for PDPM?

    By Jessie McGill, RN, RAC-MT - July 10, 2018
    CMS took the long-term care profession by surprise in April when the SNF PPS Proposed Rule revealed the Patient-Driven Payment Model (PDPM). With a proposed implementation date of October 1, 2019, PDPM would replace RUG-IV without a phase-in or blended transition. CMS provided a 60-day comment period for the public to express concerns, support, and other feedback on the proposed rule, and AANAC responded. Following weeks of collaboration with our sister organization, AADNS, and with the Expert Advisory Panel members from both organizations, members, and other stakeholder groups, AANAC and AADNS jointly submitted 25 pages of comments to CMS. (For purposes of brevity in this article, the issuer of those comments is referred to as AANAC, but the collaborative effort should be understood.)
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  • Proposed SNF Patient-Driven Payment Model (PDPM) for Medicare Part A: Technical Resources UPDATED (6/18)

    By CMS - June 20, 2018

    In May 2017, CMS released an Advanced Notice of Proposed Rulemaking (ANPRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS. Since the ANPRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I. This resulted in significant changes to the RCS-I model, which have prompted us to rename the proposed model discussed in the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) the SNF Patient Driven Payment Model (PDPM). 

    June 2018 Update: A few typographical and usability issues were recently identified by certain stakeholders with SNF PDPM the classification logic (SNF PDPM Classification Walkthrough, Grouper Tool, and NTA Comorbidity Mapping).  In order to address these issues, CMS has posted revised versions of the three files below. Stakeholders should use these revised SNF PDPM files to inform their comments on the proposed rule.
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  • CMS Touts SNF Cost Savings Under the New PDPM Payment Model

    By Caralyn Davis, Staff Writer - May 04, 2018

    Skilled nursing facilities should save approximately $2 billion in aggregate reduced administrative costs over the next 10 years ($12,000 and 183 hours in savings per provider annually), said officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 SNF PPS Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This estimate is based on the proposed changes to the skilled nursing facility prospective payment system (SNF PPS) assessment schedule associated with the Patient-Driven Payment Model (PDPM) if it’s implemented as proposed on Oct. 1, 2019.

     

    “While the current [RUG-IV] system requires substantial paperwork to track the volume of service utilization over time, PDPM eliminates the need of these frequent patient assessments and allows clinicians to focus more time on treating the patient,” noted officials. Note: PDPM is based on the Resident Classification System, Version I, or RCS-I, that CMS presented last year.

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  • SNF/LTC ODF News: Section GG Takes Center Stage

    By Caralyn Davis, Staff Writer - May 03, 2018
    The functional scores used to classify patients under the proposed Patient-Driven Payment Model (PDPM) are based on Section GG of the MDS, pointed out officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This would mark a significant change for providers because the current RUG-IV model uses Section G, as did the Resident Classification System, Version I (RCS-I) model when CMS presented it last year as an initial possibility for revamping the case-mix classification system used in the SNF PPS.
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  • SNF PPS: CMS Proposes Big Changes for Oct. 1, 2019

    By Caralyn Davis, Staff Writer - May 01, 2018

    On April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) proposed to launch a revised case-mix classification model called the Patient-Driven Payment Model (PDPM) effective Oct. 1, 2019, (i.e., starting with FY 2020) that could radically re-imagine the job of the nurse assessment coordinator (NAC). The PDPM makes the use of therapy minutes to classify a resident for payment purposes obsolete, significantly alters the PPS assessment schedule, and institutes a variable per-diem payment adjustment schedule for the first time in SNF PPS history, according to the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule.

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