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PDPM 101 - Introduction to the SNF PPS Patient-Driven Payment Model (PDPM)
Recorded On: 10/02/2018
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This presentation provides an introductory overview of the new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) payment model that will be implemented on October, 1, 2019 (Fiscal Year 2020). Specifically, the current Resource Utilization Groups, version IV (RUG-IV) per-diem case-mix payment model, which is based on resident characteristics and therapy utilization, will be replaced by a Patient Driven Payment Model (PDPM), which is based solely on resident characteristics. This represents the most significant change in how SNFs are paid since the SNF PPS was first implemented in October 1998. This presentation describes the motivations for the Centers for Medicare and Medicaid Services (CMS) to change the SNF PPS payment model, the basic design of the PDPM payment model, the specific patient assessment payment drivers and their impacts on payment rates, and the AHCA member support activities to help members prepare for PDPM implementation.
- The participant will be able to explain why PDPM is replacing the RUG-IV SNF PPS payment model on October 1, 2019
- The participant will be able to describe the key features of the PDPM payment model design including changes in assessments, payment components, per-diem rate tapering, interrupted stays, and concurrent and group therapy .
- The participant will be able to identify MDS item categories that determine each of the five case-mix-adjusted PDPM payment components.
- The participant will understand the impact of PDPM on revenues based on differences in resident characteristics and the variable PT, OT, and NTAS component per-diem payments as the length of stay increases.
- The participant will know the types of PDPM implementation member support activities and resources planned and where to find updates.
Daniel Ciolek, Associate Vice President, Therapy Advocacy, Government Relationsa
Mike Cheek, Sr. Vice President, Reimbursement Policy, Finance Policy & Legal Affairs