PDPM - The Patient Driven Payment Model

NASL 2022 Issue Briefs:


Expand Medicare Beneficiaries’ Access to Digital Health, Including Telehealth & Remote Patient Monitoring  (Feb 2022)


Support the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R. 5536) (Feb 2022)


Hospital Observation Status Harms Beneficiaries' Access to Medicare's Skilled Nursing Benefit




The Patient Driven Payment Model (PDPM) is the new reimbursement system
model that Medicare will use to determine payments for SNFs starting on
October 1, 2019. PDPM replaces the current Resources Utilization Groups (RUGs)
model.  PDPM fits into a broader push by CMS toward “patient-centered”
reimbursement models that match payment rates to the patients’ needs.

PDPM Resources:


CMS’ Patient Driven Payment Model webpage, containing CMS’ latest documents on PDPM: 
Fact Sheets, FAQs, Training Presentation, Beta version of the Grouper, and ICD-10 Mappings.


PDPM – What is Changing and What is Not?
Presentation by John Kane of CMS to NASL 2019 Winter Conference


How Nursing Homes are Preparing for PDPM
Presentation by Gov. Mark Parkinson of AHCA to NASL 2019 Winter Conference


NASL Questions on PDPM, and CMS Responses  (2018)

RUGs-IV to PDPM – Policy, Data, IT, Assessment, Compliance & Therapy Insights
Panel Presentation to the NASL 29th Annual Meeting (2018)

Panelists:  Jane Moffett, Casamba; Shawn Halcsik, Encore Rehabilitation; John Harned, BKD CPAs & Advisors; Hannah Patterson, Netsmart Technologies;
Judi Kulus, American Association of Nurse Assessment Coordination; Marc Zimmet, Zimmet Healthcare Services Group, LLC


Cognitive Based Care:  IMPACT of Outcomes, PDPM and EBP
Presentation by Renee Kinder of Encore Rehabilitation Services to the
NASL 29th Annual Meeting (2018)


Medicare Part A SNF Prospective Payment System – MDS 3.0 Captured Services as Qualifiers for Medicare Part A RUG-IV Grouper
Distributed at the NASL 29th Annual Meeting (2018)


NASL PDPM Issues and Concerns for Meeting with CMS  (2018)


FY2019 SNF PPS Proposed Rule & the Patient Driven Payment Model
​NASL Webinar presented by Cynthia Morton of NASL on May 22, 2018


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