Patient Driven Payment Model
70th AHCA/NCAL Convention and Expo
The new Medicare skilled nursing facility prospective payment system (SNF PPS) patient-driven payment model (PDPM) is based on resident characteristics reported on SNF PPS minimum data set (MDS) assessments. While the payment model itself has changed, the Centers for Medicare and Medicaid Services (CMS) has emphasized that many SNF PPS policies remain unchanged under PDPM, including SNF coverage criteria and documentation requirements to support skilled level of care as described in Chapter 8 of the Medicare Benefit Policy Manual. This session will detail the key components of the SNF level of care policies and documentation requirements associated the administrative level of care presumption, daily skilled nursing requirements, daily skilled rehabilitation requirements, and other coverage policies.