Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment Model (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 PDPM.  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 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.

CMS Targets May Release for Draft RAI Manual

Posted By: Caralyn Davis, Staff Writer
Post Date: 02/19/2019

In preparation for the Oct. 1, 2019, implementation of the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS), officials with the Centers for Medicare & Medicaid Services (CMS) had promised an early release of the draft version of the next update to the RAI User’s Manual for the MDS 3.0. However, that release won’t occur quite as early as most providers hoped.


“We historically publish that manual more toward August,” said officials during the Feb. 14 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF). “We do understand the need to be able to review [it for] the PDPM, so our goal is to have that published in May sometime this year.”


In other manual news, CMS also expects to release version 12 of the MDS 3.0 Quality Measures (QM) User’s Manual “in the next couple of months,” said officials. On Feb. 1, the QIES Technical Support Office (QTSO) announced changes to the MDS 3.0 Quality Measure Reports in the CASPER Reporting application, including calculation updates/changes to the short-stay pressure ulcer measure, the long-stay pressure ulcer measure, and the long-stay weight loss measure. The methodology for those updated QMs “is not used in the public domain yet,” said officials to justify the agency’s delay in releasing new technical specifications.

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