As anticipated, the change to the Patient-Driven Payment Model (PDPM) was finalized to go into effect October 1, 2019 (FY 2020). CMS noted that this allows providers one year to prepare for this fundamental change from the RUG-IV case-mix model to the new PDPM methodology which is based on patient condition and care needs. Preparations will involve staff education and training, internal system transitions, software development, and impact analysis. The final version of PDPM is largely the same as proposed earlier this year.
Additionally, the rule finalizes the 2.4% market basket increase for SNFs as required by the Bipartisan Budget Act of 2018 which will result in an overall increase in Medicare payments to SNFs of $820 million (effective 10/1/18). There were no new measures adopted for the SNF Quality Reporting Program (SNF QRP); however, CMS is including an added factor to consider for removal of measures for the SNF QRP.
CMS will publicly display the four assessment-based quality measures and increase the number of years of data used to display the two claims-based SNF QRP measures from one year to two years (Discharge to the Community and Medicare Spending Per Beneficiary). The SNF Value-Based Purchasing Program using the one claims-based measure (all cause 30-day hospital readmission measure) continues with updates to policies and an adjustment to the scoring methodology and an Extraordinary Circumstances Exception (ECE) policy.
Links for CMS details:
FY 2019 SNF PPS Final Rule Fact Sheet:
FY 2019 Final Rule (pre-publication copy):
This fall HTS will offer extensive education and training for our therapy staff and our partners in multiple locations to prepare for PDPM. Look for upcoming details.