PDPM discussion at Infinity Rehab

July 31, 2019


On July 30, the Centers for Medicare and Medicaid Services (CMS) issued the FY 2020 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule, which will take effect on October 1, 2019. The final rule includes updates to the payment rates used under the SNF PPS for FY 2020, as well as updates impacting the Patient-Driven Payment Model (PDPM), Quality Reporting Program (QRP), and the SNF Value-Based Purchasing Program.

A few items in the final rule:

  • The federal rates in this final rule reflect an update to the rates that CMS published in the FY 2019 SNF PPS final rule, which reflects the SNF market basket update, as adjusted by the multifactor productivity (MFP) adjustment, for FY 2020.
  • The SNF market basket percentage is 2.4 percent for FY 2020, which is an increase in payments of $851 million compared to FY 2019. This estimated increase is attributable to a 2.8 percent market basket increase factor with a 0.4 percentage point reduction for the multifactor productivity adjustment. This is a decrease from the proposed update of 2.5 percent and $887 million.
  • Effective October 1, 2019, group therapy will be defined as “a qualified rehabilitation therapist or therapy assistant treating two to six patients at the same time who are performing the same or similar activities.”
  • CMS is replacing the terminology for the five-day assessment with “initial Medicare assessment.”
  • CMS is finalizing as proposed, without modification, the process for updating the ICD-10 code mappings and lists associated with PDPM. As proposed, the process for updating the ICD-10 codes used under PDPM will take effect beginning with the updates for FY 2020.
  • The final rule updates requirements for the SNF QRP, including the adoption of two transfer of health information quality measures and standardized patient assessment data elements that SNFs would be required to begin reporting with respect to admissions and discharges that occur on or after October 1, 2020.
  • CMS is not finalizing its proposal to expand data collection for SNF QRP quality measures to all SNF residents, regardless of their payer.
  • CMS is finalizing its proposal to exclude baseline nursing home residents from the discharge to community measure.
  • CMS is finalizing its proposal to publicly display the quality measure “drug regimen review conducted with follow-up for identified issues” under the SNF Quality Reporting Program.

Find out more

View this fact sheet to find out more about these changes.

Read the pre-publication version of the final rule.

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