Navigating health reform
CMS Outlines Patient-Driven Payment Model in 2019 SNF Proposed Rule
The Centers for Medicare and Medicaid Services (CMS) released the 2019 proposed Skilled Nursing Facility (SNF) rule. The complete proposed rule (CMS-1696-P) can be downloaded from the Federal Register. The comment deadline is June 26, 2018.
Among the topics addressed in the proposed rule, the Patient-Driven Payment Model (PDPM) is a primary focus. This case-mix classification derives payment classifications almost exclusively from verifiable resident characteristics, not volumes of services. The new system will adjust five different case-mix components for the varied needs and characteristics of a resident’s care, and then combine these with the non-case-mix component to form the full SNF Prospective Payment System per diem rate for that resident. This new model would begin on October 1, 2019. CMS proposes additional changes under the PDPM for reporting therapy services, SNF swing bed assessments, and SNF resident assessments.
Additional provisions of interest
Other provisions in the rule include:
- Market basket update
- SNF Value-Based Purchasing Program
- Promoting interoperability
How we can help
CliftonLarsonAllen’s (CLA) Regulatory Advisor offers a summary of the proposed rule’s key provisions, and condenses pages of regulation into an accessible format that translates complex issues into understandable terms. Especially during the next phase of changes in our health care system, health care leaders can rely on CLA to monitor CMS publications and provide resources to help prepare for the future.Download the Regulatory Advisor