The FY 2019 skilled nursing facility (SNF) prospective payment system (PPS) proposed rule, published on May 8, includes a very complex patient driven payment model (PDPM) replacing resource utilization groups and favoring hospital-based SNFs.
There have been long-standing concerns with SNF PPS’s reliance on therapy minutes to set payments, so after five years of reform research by the Centers for Medicare & Medicaid Services (CMS), this new proposed rule for the PDPM model will set per diem payments using five case-mix elements: Physical therapy, occupational therapy, speech-language pathology, nursing and new, non-therapy ancillaries (NTA). Ten clinical categories are proposed, which CMS feels will capture the full range of SNF patients.
Comments are due by June 26. For more information click here.
The proposed new case-mix classification system (the PDPM) would be effective October 1, 2019.