All certified Medicare and/or Medicaid nursing facilities must use the revised RAI 3.0 user manual v1.17, effective October 1, 2019. In the updated version, the new Medicare Part A payment model, the Patient Driven Payment Model (PDPM) is introduced. The PDPM will replace the Resource Utilization Group (RUG)-IV. RUG-IV is a case-mix payment model currently used for Medicare Part A Prospective Payment System (PPS) reimbursement of skilled services provided in skilled nursing facilities (SNF) or swing bed (SB) hospitals. The case-mix system has been used for over 20 years. Under RUG-IV, SNF Medicare payments are based primarily on the amount of therapy provided to a patient/resident. The RUG-IV payment model will end on September 30, 2019 and PDPM will start on October 1, 2019. There is no transition period between the two payment models.
The PDPM system uses information from the Minimum Data Set (MDS) assessment to classify group categories in the SNFs and SB hospitals that are Medicare certified. The changes to PDPM improve payment accuracy and appropriateness. PDPM reduces administrative burden on providers.
The new PDPM two-day provider’s training conducted by the Centers for Medicare and Medicaid Services (CMS) in May and August of 2019 is now available on demand at the CMS SNF Quality Reporting Program (QRP) web site.
The 5-Day PPS and the Interim Payment Assessment (IPA) are the new required Medicare Part A assessment under the new PDPM policy. Detailed instructions for these two new item sets are included in the revised RAI 3.0 manual v1.17. The new MDS 3.0 Item Sets (MDS Forms) are available and can be downloaded from the RAI 3.0 manual link under Appendix H. Please follow the links below:
For additional questions, please contact the MDS/OASIS Help Desk by email at firstname.lastname@example.org or by phone at (916) 324-2362.
Please distribute copies of this AFL to MDS Coordinators, Directors of Nursing, and Facility Administrators in your facility.
Original signed by Heidi W. Steinecker
Heidi W. Steinecker