The new PDPM, Patient Driven Payment Model schedule only requires 3 PPS assessments, the 5-day, interim, and discharge assessments. CMS has made worksheets available to calculate the PDPM categories that replace RUGs.

MDS items added include: the Primary Diagnosis in Section I, Surgical History categories in Section J, Interim Performance in Section GG, and additional Discharge Therapy items in section O.

The streamlined assessment policy is intended to provide more time for comprehensive baseline nursing care plans.

PPDM, the Patient-Driven Payment Model begins October 1, 2019. CMS reports the new case-mix classification system will use certain clinical factors rather than volume based services to determine Medicare reimbursement. Classification will be based on the resident’s primary diagnosis, therapy components, and functional status to assign one of 16 case mix groups. The link below provides detailed information, crosswalk tables, and learning materials.

CMS Patient Driven Payment Model Information Page

Long term care facilities must develop and implement a baseline care plan for each resident within 48 hours of admission beginning November 28, 2017, according to recently updated surveyor guidelines published by CMS.

The guidelines state the 48 hour baseline care plan must include “the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care,” including, but not limited to: initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendation, if applicable.

According to the regulations, facilities may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan meets all of the requirements for the baseline care plan outlined in the surveyor guidelines.

In order to assure all of the requirements of the guidelines are met, LTCS Books recommends that the facility develops and implements a comprehensive care plan within 48 hours of admission.

MDS Comprehensive Assessment v1.15.1 for October 2017

Baseline Care Plan Regulations

CMS Updated Surveyor Guidelines for Long Term Care Faciities

The VBP, Value Based Purchasing Program, became effective October, 2018. With the changes, CMS states the highest performing SNFs receive the highest payments, and the lowest ranked 40 percent of SNFs receive decreased payments.

Performance rankings are based on unplanned hospital readmissions of Medicare residents within 30 days of discharge, performance scoring, and quality feedback reports.

Overview of the Skilled Nursing Facility Value-Based Purchasing Program