Information and resources on Medicare payment and policies in Skilled Nursing Facilities (SNFs). If you have questions about this information, contact firstname.lastname@example.org.
Proposed New SNF PPS Payment Methodology: Patient-Driven Payment Model (PDPM)
On April 27, 2018, CMS released its proposed 2019 prospective payment system (PPS) for skilled nursing facilities (SNFs), which includes plans to replace the existing SNF case-mix methodology, known as Resource Utilization Groups Version IV (RUG-IV), with an entirely new system CMS is calling the Patient-Driven Payment Model (PDPM). CMS believes the new model will save money and improve care by reducing administrative burden and tying payment to patient conditions rather than services provided.
Under the PDPM, payments would be based on a resident's classification among 5 components—physical therapy, occupational therapy, speech-language pathology, nursing, and "non-therapy ancillary services," a category mostly related to drugs and medical supplies. Payment would be calculated by multiplying the case-mix index for the resident's group with each component, first by a base payment rate and then by days of service received. The payment calculations for each component would then be added together to create a resident's total per diem rate.
For more information, see the CMS fact sheet on the proposed rule or APTA's comment letter sent June 22, 2018 posted below.