On August 8, 2018, CMS published the Fiscal Year 2019 SNF Prospective Payment System (SNF PPS) final rule, which details the replacement of the RUG-IV model with a revised case mix methodology called the Patient-Driven Payment Model (PDPM) that will take effect October 1, 2019.
PDPM is considered budget-neutral in the aggregate payment to SNFs; this means the funds currently allocated for SNF care are redistributed among the different rate components for PDPM. While RUG-IV is based on a therapy and nursing component, those same dollars are now allocated into five case mix components under PDPM:
- Physical Therapy (PT)
- Occupational Therapy (OT)
- Speech Language Pathology (SLP)
- Non-Therapy Ancillary (NTA)
The beneficiary qualifies for one case mix group in each of the five components. Each component yields an individual rate, and these individual rates will be added together to achieve the total per diem rate. This tool-kit is intended to provide at-a-glance resources to assist in understanding the five components of PDPM.
- Tool Kit Introduction & Overview
- PT / OT Case-Mix Classification Group
- Speech-Language Pathology Classification Group
- Nursing Case-Mix Group Classification
- Non-Therapy Ancillary Case-Mix Group Classification
- Nursing Case-Mix At-A-Glance Grouper Tool
- MDS Items Impacting PDPM