October 2019 Transition to the Patient Driven Payment Model (PDPM)

1. October 2019 Transition to the Patient Driven Payment Model (PDPM) October 2019

2. Disclaimer • This presentation was current at the time it was presented. Be aware CMS may continue to make revisions after the October 1, 2019 release date. • Links to source documents have been provided for your reference.

3. The majority of the data sets and RAI Manual changes on October 1, 2019 were a result of changes to the system for reimbursement for SNF Medicare A residents

4. PDPM • CMS believes by focusing on the individual needs and characteristics of each SNF resident, reimbursement will better reflect the residents specific needs. • RUG-IV is primarily driven by the volume of therapy provided • PDPM looks at therapy, nursing needs and non-therapy ancillary services

5. RUG-IV to PDPM • There was no transition period between RUG-IV & PDPM • RUG-IV officially ended September 30, 2019 • PDPM officially began October 1, 2019

6. RUG-IV to PDPM • In order to receive a RUG-IV HIPPS code that can be billed for services furnished prior to October 1, 2019. • You must complete an assessment with an ARD set on or prior to September 30, 2019. • The usual 14-day completion period and 14-day transmission period still apply.

7. Reported RUG-IV ISSUES • Due to an early release of the PDPM software coding package, providers reported problems with error codes (some fatal) on their final validation reports when submitting MDS data into the ASAP system. • If you attempted to submit MDS data to establish a RUG-IV HIPPS code and received an error code, it was recommended to wait and re-submit the assessment.

8. RUG-IV to PDPM • For residents admitted prior to Oct 1, 2019, but whose stays continued past that date. • In order to receive a PDPM HIPPS code for use in billing services furnished on or after October 1, 2019 • An IPA must be completed with an ARD no later than October 7, 2019.

9. PDPM Assessments and Grouper Updates • In response to identified grouper discrepancies reported by providers, CMS released a revision to the PDPM coding package on 10/7/19. • This revision corrected the identified grouper discrepancies. • Be aware you are still required to be in compliance with timeline requirements for assessment including establishing ARDs for OBRA or PPS assessments, including the IPAs

10. Reminders • No changes have occurred to the assessment schedule requirements for OBRA assessments. • All completion and transmission timelines still apply. • (Dually coded 01/01 assessments must have an ARD set no later than day 8)

11. Reminders • IPA assessments are always stand alone assessments and may not be merged with any other PPS or OBRA assessment • OBRA discharge assessments and Medicare A discharge assessments may still be merged when the resident leaves the facility within one day of the Medicare A discharge.

12. Resources Joy Ramsby State RAI Coordinator Nursing Facility Survey Unit Joy.M.Ramsby@state.or.us 503-407-1488 Sheryl Luper QIES/MDS/OASIS/ASPEN Coordinator Sheryl.L.Luper@state.or.us 503-602-5162

13. Resources • PDPM@cms.hhs.gov • Questions related to PDPM implementation and policy • MDSTechIssues@cms.hhs.gov • Questions regarding technology questions