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PDPM Status Updates - for AHCA SNF Members
Contains 8 Component(s) Includes a Live Event on 10/24/2019 at 3:00 PM (EDT) Recorded On: 10/11/2019PDPM Status & Updates Webinar - for AHCA SNF Members
Click the
button found in the upper right corner of your screen
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
PDPM Status & Updates Webinar - for AHCA SNF Members
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CMS PDPM-Related PDPM/MDS/SNF QRP Resources
Contains 63 Component(s)On May 7-8, 2019 and again (with minor updates) on August 13-14, 2019 the Centers for Medicare and Medicaid Services (CMS) conducted a two-day train-the-trainer session on the October 1, 2019 updates to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Examples of agenda items directly relevant to PDPM include: discussions on how to properly code Section GG of the MDS, Changes in Sections A, I, J, and O of the MDS, PDPM: What is changing and what is not, and Integrated coding & PDPM Case Study. This PDPM Academy toolkit includes all available CMS agenda, slides, and video resources related to these training dates. Additionally, this toolkit contains a direct link to the CMS PDPM-Related MDS-RAI Resources webpage containing the most current minimum data set resident assessment instrument (MDS-RAI) manual. Scroll to the bottom of the page and download the file under “Related Links” labeled MDS 3.0 RAI Manual v1.17 October 2019. • Chapter 2 contains a significant rewrite due to the elimination of the RUG-IV scheduled and unscheduled assessment types, and the introduction of the new SNF PPS Interim Payment Assessment (IPA) as well as the new Optional State Assessment (OSA). • Chapter 3 contains instructions for completion of new or revised MDS items that impact PDPM and SNF QRP, including new Sectikon J2100-J5000 surgery items and I0020B primary reason for the SNF stay ICD-10 diagnosis code. • Chapter 6 is a complete rewrite of the SNF PPS resident classification process and other policies including the new IPA, interrupted stay, and late assessment/default payment policies.
How to Register in ahcancalED
Easy as 1, 2, 3 !
click the
Step 1
Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.
Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have one or can’t remember?
Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.
*Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go.
Step 2
From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays.
Under “upcoming webinars” go to a product in which you are interested. Click on the title.
You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.
Step 3
Almost there!
Click the green “register” button.
Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.
FYI: after registering, you will be automatically notified when the recording of the webinar is ready.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
On May 7-8, 2019 and again (with minor updates) on August 13-14, 2019 the Centers for Medicare and Medicaid Services (CMS) conducted a two-day train-the-trainer session on the October 1, 2019 updates to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Examples of agenda items directly relevant to PDPM include: discussions on how to properly code Section GG of the MDS, Changes in Sections A, I, J, and O of the MDS, PDPM: What is changing and what is not, and Integrated coding & PDPM Case Study. This PDPM Academy toolkit includes all available CMS agenda, slides, and video resources related to these training dates.
Additionally, this toolkit contains a direct link to the CMS PDPM-Related MDS-RAI Resources webpage containing the most current minimum data set resident assessment instrument (MDS-RAI) manual. Scroll to the bottom of the page and download the file under “Related Links” labeled MDS 3.0 RAI Manual v1.17 October 2019.
- Chapter 2 contains a significant rewrite due to the elimination of the RUG-IV scheduled and unscheduled assessment types, and the introduction of the new SNF PPS Interim Payment Assessment (IPA) as well as the new Optional State Assessment (OSA).
- Chapter 3 contains instructions for completion of new or revised MDS items that impact PDPM and SNF QRP, including new Sectikon J2100-J5000 surgery items and I0020B primary reason for the SNF stay ICD-10 diagnosis code.
- Chapter 6 is a complete rewrite of the SNF PPS resident classification process and other policies including the new IPA, interrupted stay, and late assessment/default payment policies.
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Workforce - What Works!
Contains 2 Component(s) Recorded On: 05/09/2019Workforce is consistently noted as one of the top challenges that providers face. This course contains a series of short webinars where providers share solutions that have helped them combat some of the top workforce challenges - from recruitment to staff engagement. Additional webinars will be posted throughout the year, so check back for more!
Workforce is consistently noted as one of the top challenges that providers face. This course contains a series of short webinars where providers share solutions that have helped them combat some of the top workforce challenges - from recruitment to staff engagement.
Additional webinars will be posted throughout the year, so check back for more!
Heidi Geel
RN, SDC/QAPI of Maine Veterans’ Homes-Machias, Maine
For the past 24 years, I have worked in various settings as a Registered Nurse; I love the diversity that this profession offers! Just over 4 years ago, I arrived at MVH-Machias, as the QAPI and Staff Development Coordinator. In my previous job, I had visited the facility many times and I love to tell people that there is a reason I work where I do now. MVH-Machias is one of the best assisted living facilities in Maine, and now one of the best in the country, as evidenced by winning the prestigious AHCA/NCAL GOLD Quality Award in 2018. Being part of the quality award journey was a difficult but exciting experience, one of great learning and transformation.
I have lived most of my life in a tiny community in rural Maine with my husband, sons and their families. I love my role as an RN but the role of ‘Nana’ to my 4 grandchildren is my favorite.
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CMS MDS Section GG Training Resources
Contains 6 Component(s)The SNF PPS Patient Driven Payment Model (PDPM) relies on accurate coding of several MDS Section GG mobility and self-care items that impact the PT, OT, and Nursing component per-diem case-mix payment rates. This toolkit contains a collection of Section CC training materials that the Centers for Medicare and Medicaid Services (CMS) has provided on their website that may be useful for provider PDPM training of nurses, certified nursing assistants, and therapists.
How to Register in ahcancalED
Easy as 1, 2, 3 !
click the
Step 1
Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.
Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have one or can’t remember?
Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.
*Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go.
Step 2
From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays.
Under “upcoming webinars” go to a product in which you are interested. Click on the title.
You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.
Step 3
Almost there!
Click the green “register” button.
Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.
FYI: after registering, you will be automatically notified when the recording of the webinar is ready.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
The SNF PPS Patient Driven Payment Model (PDPM) relies on accurate coding of several MDS Section GG mobility and self-care items that impact the PT, OT, and Nursing component per-diem case-mix payment rates. This toolkit contains a collection of Section CC training materials that the Centers for Medicare and Medicaid Services (CMS) has provided on their website that may be useful for provider PDPM training of nurses, certified nursing assistants, and therapists.
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CMS PDPM Program Manual Updates
Contains 4 Component(s)The Centers for Medicare and Medicaid Services (CMS) has issued sub-regulatory guidance related to the Skilled Nursing Facility Medicare Part A Prospective Payment System (SNF PPS) Patient Driven Payment Model (PDPM) in recent Progrram Manual update transmittals. The most current updates and related resources are provided in this folder.
Click the
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
The Centers for Medicare and Medicaid Services (CMS) has issued sub-regulatory guidance related to the Skilled Nursing Facility Medicare Part A Prospective Payment System (SNF PPS) Patient Driven Payment Model (PDPM) in recent Progrram Manual update transmittals. The most current updates and related resources are provided in this folder.
- Medicare General Information, Eligibility, and Entitlement Manual PDPM Updates (October 4, 2019) (Bobbie – use the R126GI file)
- Medicare Benefit Policy Manual PDPM Updates (October 4, 2019) (Bobbie – use the R261BP file)
- Medicare Claims Processing Manual PDPM Updates (October 4, 2019) (Bobbie – use the R261CP file)
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Communication Tools
Contains 3 Component(s)This toolkit includes: Talking Points, Template Letter for Families, Template Letter for Referral Sources/Payors
Click the
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
This toolkit includes:
- Talking Points
- Template Letter for Families
- Template Letter for Referral Sources/Payors
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TRICARE SNF Payment Policies Impacted by PDPM
Contains 3 Component(s)TRICARE provides health care benefits to active military personnel and their families. TRICARE has three regions: East, West, and Overseas. Each TRICARE region has its own managed care support contractor (MCSC) who is responsible for administering the TRICARE program in each region. The MCSCs establish the provider networks and conduct provider education. At a minimum, all TRICARE providers must be authorized/certified under TRICARE Regulation and must have their authorization/certification status verified by the managed care support contractors (MCSCs) in each region. There are two types of TRICARE-authorized providers: Network and Non-Network Providers
Click the
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
TRICARE provides health care benefits to active military personnel and their families. TRICARE has three regions: East, West, and Overseas. Each TRICARE region has its own managed care support contractor (MCSC) who is responsible for administering the TRICARE program in each region. The MCSCs establish the provider networks and conduct provider education. At a minimum, all TRICARE providers must be authorized/certified under TRICARE Regulation and must have their authorization/certification status verified by the managed care support contractors (MCSCs) in each region. There are two types of TRICARE-authorized providers: Network and Non-Network Providers
Network Providers: To become a network provider, a SNF will sign a contractual agreement with the MCSC in the applicable region. In the contract the SNF will: 1) Agree to provide care to TRICARE beneficiaries at a negotiated rate, 2) Accept the beneficiaries' copayment or cost share as payment in full, and 3) File claims with TRICARE for the remaining amount.
Non-Network Providers: If a SNF doesn’t want to sign a contract, the center can be a non-network provider, but the SNF must be certified by the MCSC. As a non-network provider the SNF can decide to be a "participating provider" or a "non-participating provider". Participating providers agree to file claims for beneficiaries, to accept payment directly from TRICARE and to accept the TRICARE allowable charge as payment in full for their services. Non-participating providers do not agree to accept the TRICARE allowable charge or file beneficiary claims. Non-network providers can choose to participate on a claim-by-claim basis. A SNF doesn’t have to be participating or non-participating all of the time.
TRICARE Relationship with PDPM: Historically, the TRICARE coverage and payments to SNFs have mirrored the Medicare SNF PPS payment model, however it appears that TRICARE is not converting to PDPM at this time. This toolkit contains the most current available information related to the TRICARE SNF payment policies.
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Tools to Prevent and Address Resident to Resident Mistreatment
Contains 3 Component(s)It is critical for nursing centers and assisted living communities to address and mitigate reported incidents of resident-to-resident mistreatment. While mistreatment may or may not meet the definition of abuse, it would include negative and aggressive physical, sexual, or verbal interactions between long-term care residents that is unwelcome and have high potential to cause physical or psychological distress in the recipient.
Click the
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
It is critical for nursing centers and assisted living communities to address and mitigate reported incidents of resident-to-resident mistreatment. While mistreatment may or may not meet the definition of abuse, it would include negative and aggressive physical, sexual, or verbal interactions between long-term care residents that is unwelcome and have high potential to cause physical or psychological distress in the recipient.
Objectives:
- Conduct a thorough investigation with proper documentation, follow up, and monitoring and care planning as needed.
- Create a structured self-assessment process to address the resident-to-resident mistreatment and minimize similar events for all residents. This includes a need to:
- Document immediate interventions;
- Conduct a root cause analysis process to identify the specific/source, root cause or causal factor of the problem; and
- Identify future actions to ensure sustained efforts to identify and prevent potential resident-to-resident mistreatment.
- Identify existing AHCA/NCAL resources to support providers in addressing resident-to-resident mistreatment.
Note: These tools were developed by members of AHCA/NCAL’s Survey/Regulatory Committee to assist centers and communities in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools.
You are also encouraged to register for these free resources:
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Veterans Administration (VA) SNF Payment Policies Impacted by PDPM
Contains 9 Component(s)The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year. Community providers are a vital part of VA’s high-performing health care network; making sure Veterans who have served our country and their families get the timely, high-quality health care they need. With community care, Veterans and their family members (dependents) can receive care from a local provider in their community depending on specific eligibility requirements, their medical needs and circumstances, care available at VA, and other factors.
Click the
OR
Follow these three easy steps below!
Step 1
Click the orange log in button in the upper left hand corner.
Use your user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.
Don’t have an account or can’t remember?
Click the CREATE ACCOUNT button.
Non-members can create an account with your first, last name and email.
AHCA/ NCAL Members - *Please note* you must add your member facility name to your login
Once you are in and can see your name in the upper left hand corner, you are ready to go!
Step 2
From the home page click on a category (Resources, Training, Webinars or On-Demand Training) For this demonstration, let’s try Webinars- Upcoming Live.
On the “upcoming webinars” page go to a product in which you are interested. Click the green REGISTER button.
Or click the title of the webinar and you will be redirected to the page where you can view the overview, handouts or resources associated with that product. You can also click REGISTER in the upper right hand corner. The content will be available in your dashboard.
Step 3
Almost there!
If the resource you are trying to access is a paid-for product, fill out the registration details and voila! The products are yours to use and can be found in your dashboard.
Need further help? Email us at educate@ahca.org
We’ll walk you through it.
The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year. Community providers are a vital part of VA’s high-performing health care network; making sure Veterans who have served our country and their families get the timely, high-quality health care they need. With community care, Veterans and their family members (dependents) can receive care from a local provider in their community depending on specific eligibility requirements, their medical needs and circumstances, care available at VA, and other factors.
Community-based skilled nursing providers may furnish short-term and long-term care to veterans under VA benefits under one of the three programs identified below:
- 1.Patient-Centered Community Care (PC3) is a nation-wide network of community providers VA uses to refer Veterans to community care under specific circumstances. PC3 is intended to provide eligible Veterans with access to medical care when services are not readily available or accessible at their local VA medical facility.
- 2.Community Care Network (CCN): In an effort to streamline VA’s community care programs, the president signed the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, referred to as the “MISSION Act,” into legislation on June 6, 2018, providing more choices and robust care coordination for Veterans using one consolidated program instead of multiple programs. A significant component of having one method for Veterans to receive care from community providers, although not dependent on the legislation, are the Community Care Network (CCN) contracts to be awarded to as many as four contractors covering an established set of regional boundaries to ensure health care services and resources are available to our diverse Veteran population. To establish the new CCN, VA released a request for proposal for private sector companies to develop and administer regional networks of high-performing licensed health care providers who will work together with VA providers and practitioners to provide medical, dental, and pharmacy services to Veterans who are unable to receive care at local VA medical centers. The CCN contracts were developed with a focus on transparency, accountability, quality, and increased communications between VA and Veterans.
- 3.Veterans Care Agreements (VCA): VA may enter into agreements with certain community providers to care for Veterans when they are not part of VA’s contracted community care network. These agreements are known as Veterans Care Agreements (VCA), which are intended to be used in limited situations where contracted services through VA’s community care network are either not provided or not sufficient to ensure Veterans can get the care they need. VA may only purchase care for Veterans through these contract vehicles such as the Patient-Centered Community Care (PC3) network or the Community Care Network (CCN), or by establishing a VCA. Providers interested in establishing a VCA should contact their closest VA medical facility. In some cases, VA medical facilities may reach out to community providers to request they establish a VCA where there is a need for services not adequately covered through VA’s contracted network.
VA Relationship with PDPM: Historically, the VA program payments to SNFs have varied regionally, with many locations having based payments on the Medicare SNF PPS RUGs payment model. While certain parts of the VA system are transitioning to PDPM on October 1, 2019, other parts appear to be continuing to base payments to SNFs under the RUGs model, or under other previously established contracted rates with individual providers, for at least a short period. This toolkit contains the most current available information related to the VA SNF payment policies.
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PDPM and Medicare Advantage Toolkit
Contains 6 Component(s)Because SNF providers contract directly with MA plans, it is essential that both parties understand any changes in resident assessment and claims processing that may be necessary to assure that beneficiary access and provider cash flow are not interrupted. To assist, AHCA has added new resources to the PDPM and Medicare Advantage Toolkit that providers can use to help prepare for discussions with Medicare Advantage (MA) plans prior to October 1 to help assure a seamless transition as the SNF PPS transitions to PDPM.
Because SNF providers contract directly with MA plans, it is essential that both parties understand any changes in resident assessment and claims processing that may be necessary to assure that beneficiary access and provider cash flow are not interrupted. To assist, AHCA has added new resources to the PDPM and Medicare Advantage Toolkit that providers can use to help prepare for discussions with Medicare Advantage (MA) plans prior to October 1 to help assure a seamless transition as the SNF PPS transitions to PDPM. The Toolkit includes:
- For Providers – PDPM Impact on Medicare Advantage - PDPM Impact on Medicare Advantage, containing an overview of the impact that PDPM may have on your existing MA contracts and out of network payments, as well as suggested questions for health plans to ease the transition.
- Sample PDPM Survey for Medicare Advantage Health Plans - with sample questions to ask plans to better understand what operational and billing procedures regarding MA residents you may have to change on 10/1.
- PDPM in Medicare Advantage Contracts Readiness Checklist - to ensure you are fully prepared under your existing MA contracts and for out of network payments.
- PDPM Impact on Medicare Advantage Webinar - which reviews the recommendations and resources above.
