Tag Archives: cms

CMS Announces SNF PPS and PDPM Final Rule. Here are the Changes…

July 31st, 2018, the Centers for Medicare & Medicaid Services (CMS) announced the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) – including – Patient-Driven Payment Model (PDPM). There were no significant changes in the final rule as compared to the proposed rule.   We have highlighted key takeaways below. There will be a market basket increase of 2.4% ($820 million) – Effective October 1, 2018. Patient-Driven Payment Model (PDPM) – Effective October 1, 2019 PDPM will be a major shift away from volume-based services (RUG-IV) with the new focus being value-based services and is designed to treat the needs of … Continue reading

Patient-Driven Payment Model (PDPM) Update

Patient-Driven Care Under PDPM (via cms.gov)

In May 2018, a new value-based reimbursement proposal, Patient-Driven Payment Model (PDPM), was introduced by CMS. CMS believes PDPM is an improvement over the RUG-IV and Resident Classification System (RCS-1) models because it better accounts for resident comorbidities and patient-specific care needs while reducing the emphasis of therapy minutes. PDPM is also designed to decrease administrative complexities (paper work!) through an overhaul of required MDS schedules. PDPM is budget-neutral and classifies each resident into five categories (PT, OT, SLP, Non-Therapy Ancillaries, and Nursing) and provides a single payment based on the sum of these individual classifications. The new model is on … Continue reading

What’s on the Horizon for 2017?

niels-bohr

“Predictions are hard, especially about the future.” Niels Bohr Nobel Laureate in Physics   Some would call it foolish to try to predict how the Trump administration and the 115th Congress will shape health care in 2017, but here it goes anyway! I think it is safe to assume that value-based payment is likely to survive, but it may look different in terms of structure. The HHS secretary-nominee, Dr. Tom Price, is not a fan of mandatory initiatives, such as the Comprehensive Care for Joint Replacement (CJR) bundled payment program which began in April last year. The CMS Innovation Center … Continue reading

Accountable Health Communities Model

Social Deteminants of Health

On January 5, 2016, the Department of Health and Human Services announced $157 million in funding to address the health-related social needs of Medicare beneficiaries and associated referrals to and navigation of community-based services. Called the Accountable Health Communities Model, it is a 5-year program and the first CMS Innovation Center model to focus on health-related social needs of Medicare and Medicaid beneficiaries. For a health care system that has historically focused on funding care that occurs in a clinic, hospital, or nursing facility, this is a significant advancement. It is a novel approach for testing whether screening patients for … Continue reading

HHS Announces Timeline for Transition from Fee-for-Service to Value-Based Payment Models

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From the National Association for the Support of Long-term Care: On January 26, Sylvia M. Burwell, Secretary Department of Health and Human Services (HHS) announced a significant new initiative to transition payments under the traditional, Medicare fee-for-service program to alternative value-based payment models. HHS set a goal of achieving value-based payments through the use of alternative payment models for 30 percent of Medicare fee-for-service payments by the end of 2016, and 50 percent of payments by the end of 2018. In addition, HHS announced a separate goal of linking 85 percent of all Medicare fee-for-service payments to quality or value … Continue reading

Legislation Affecting Therapy Coverage

At Infinity Rehab, we actively advocate on behalf of therapists and those who we serve. A component of that advocacy is relaying important information about the access of therapy services. Below is an update from the American Health Care Association and the National Center for Assisted Living detailing an upcoming legislative change that may affect access to physical therapy, occupational therapy, or speech language pathology services. AHCA and NCAL are supporting an extension of the current cap exceptions and have worked with a coalition of patient, consumer, and healthcare provider organizations to identify simple and practical process improvements that were submitted … Continue reading