FY2019 SNF PPS Proposed Rule Analysis – Part III: PDPM Summary

Patient paying bill, pulling card out of wallet

Part III: Patient-Driven Payment Model

In addition to payment and policy updates for fiscal year (FY) 2019, the skilled nursing facility (SNF) proposed rule includes a proposal to revise the payment model from the current Resource Utilization Groups (RUG-IV) case-mix classification to the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019 for FY 2020.

The proposed rule offers the opportunity to provide feedback to CMS. LeadingAge will be submitting comments and seeks specific member feedback on the following topics covered in this article:

  • Expansion from 2 case-mix components to 5 case-mix components and the classification approaches within each.
  • Use of variable per-diem rates for physical therapy (PT), occupational therapy (OT), and non-therapy ancillary (NTA) case-mix components.
  • Changes to the Minimum Data Set (MDS) assessment schedule.
  • Impact of the proposed change on nonprofit SNFs.

According to a 2017 comparison between PDPM and RUG-IV, nonprofit and government-owned SNFs would see increases of 1.9% and 4.2% respectively. Smaller SNFs see increases while those with a capacity of greater than 100 certified units might expect declines. Rural providers would see increases as would facilities that serve residents with less therapy utilization. CMS has made available a number of provider-specific tools that we encourage you to examine to estimate facility specific impacts. A provider-specific PDPM impact analysis is available for the fiscal year 2017 and represents estimated payments under PDPM, assuming no changes in provider behavior or resident case-mix.

This article summarizes highlights of the proposed changes that CMS has described in the proposed rule supported by research in a technical report.

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Find the original article here. leadingage.org.com