PDPM Status & Updates Webinar - for AHCA SNF Members

AHCA/NCAL CEO Mark Parkinson and Senior Vice President for Reimbursement Policy Mike Cheek will provide an overview of the proposed rule CMS recently issued.

​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.

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.

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.