Find educational and training resources to assist stakeholders in preparing for PDPM implementation.
- In July 2018, the Centers for Medicare and Medicaid Services (CMS) finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Medicare Part A stay.
- In September 2022, CMS announced that they would be removing Section G, which contained detailed information regarding a resident’s ADL function, from the Minimum Data Set (MDS) effective October 1, 2023. This Section is replaced by Section GG, which consists of a limited evaluation of functional status.
- The Department has elected to adapt its nursing facility reimbursement methodology to accommodate the MDS changes associated with PDPM.
Current Status of Adoption of PDPM
The Department has convened the PDPM workgroup, consisting of Department staff, nursing facility industry representatives, and other stakeholders. At stakeholders’ request, the Department has agreed to defer the actual transition to PDPM until January 1 through July 1, 2025. Because the changes to the MDS affecting reimbursement are scheduled to go into effect October 1, 2024, the Resource Utilization Group (RUG) case mix index (CMI) will not be calculated for dates on or after October 1, 2023. Instead, the Department will “freeze” the CMI at either:
The CMI in effect on September 30, 2023 (Q3 23), or
An average of CMI rates for multiple quarters.
The Department has requested stakeholder input on how to calculate the “frozen” CMIs.
The proposed timetable for implementing PDPM is below:
*Nursing facility rates will also be rebased effective 7/1/2024.
CMS Patient Driven Payment Model
For more information, please contact Wajiha Farooqi, Cost Reporting and Rate Setting Manager, at (410) 458-1689 or at firstname.lastname@example.org.