Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment Model (PDPM) is here, and AANAC will continue to help you through the transition. Visit this page frequently for new tools, education, and resources for ongoing success under PDPM.

Final PDPM Grouper DLL V1.0008 (REVISED) Effective Oct. 1, 2020

Posted By: CMS
Post Date: 10/12/2020

An update to the PDPM Grouper DLL has been posted, along with its source code and test cases.  This version, V1.0008, corrects an issue with a dynamic array that was not consistently reinitialized when processing multiple assessments within a short time frame.  This occasionally caused incorrect PDPM recalculation results when processing pre- and post- 10/01/2020 assessments.

The FINAL version of the PDPM Grouper supports the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets.  Note that the grouper will return 4-character codes for these OBRAs.

It is important to include the control item STATE_PDPM_OBRA_CD (as defined in the V3.00.5 errata for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications) for assessments with target date on or after October 1, 2020.  

Note that this FINAL version supports the ICD-10 codes that are defined in the data specifications as valid for item I0020B for FY2021.  Also, please note that the grouper expects valid FY2021 ICD-10 codes for I8000A-J when processing assessments with target date on or after October 1, 2020.  

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