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.
November 28, 2018: CMS released "All-Cause Harm Prevention in Nursing Homes: Change Package to Prevent Harm." This change package describes successful practices of high-performing nursing homes to prevent harm while honoring each resident's rights and preferences. The resource is organized by overarching themes and includes strategies to prevent specific adverse events and abuse. The change package is a key resource for anyone interested in improving the quality of life and quality of care for those living in nursing homes, such as nursing home administrators, directors of nursing, unit directors and managers, health care providers, and owners; residents and families; and long-term care stakeholders.
New SNF PPS Payment Methodology: Patient-Driven Payment Model (PDPM)
On August 8, 2018, CMS published its final 2019 prospective payment system (PPS) for skilled nursing facilities (SNFs), which outlines the agency's plans to replace the existing SNF case-mix methodology, known as Resource Utilization Groups Version IV (RUG-IV), with an entirely new system called 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. Review more PDPM information and resources.
Under the PDPM, payments will 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 will 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 will then be added together to create a resident's total per diem rate.
For more information, see the CMS fact sheet on the final rule or APTA's fact sheet on the final rule posted below.
Information on New Payment Methodologies for SNFs and Home Health Agencies
CMS is implementing significant changes that will affect payment for SNFs beginning in FY 2019 and for home health services beginning in CY 2020. Included are the new Patient-Driven Payment Model (PDPM) in skilled nursing facilities and the Patient-Driven Groupings Model (PGPM) in home health. APTA's webpage of resources on these models includes a recorded "myth-busting" webinar on the PDPM and PDGM, and background on both models with links to further information and explanation.