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 CMS Issues Final Rule Covering 2019 Medicare Payment Rates, PDPM

The Centers for Medicare & Medicaid Services (CMS) on July 31 finalized the Fiscal Year (FY) 2019 Medicare payment rule for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), providing a 2.4 percent payment increase, or $820 million more in aggregate payments. The aggregate payments are $30 million below the $850 million that CMS outlined in a draft proposal in late April. ​

In tandem with the SNF PPS, CMS also finalized its proposed new SNF payment design, the Patient Driven Payment Model (PDPM) that it also first unveiled this past spring. The PDPM starts FY 2020 with an effective date of Oct. 1, 2019.

Separate from the SNF universe, CMS published final rules for the Inpatient Rehabilitation Facility PPS and Inpatient Psychiatric Facility PPS.

The PDPM replaces the previous CMS proposal for a new SNF payment system, the so-called Resident Classification System, Version 1, or RCS-1. CMS said the change would benefit providers, stressing that the PDPM includes an 80 percent cut in payment group combinations and far fewer reporting requirements, which could save providers $2 billion a year.

PDPM is composed of five case-mix-adjusted payment components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and Non-Therapy Ancillaries Services (NTAS). Reimbursement would be based on the sum of the five component rates.
  
Read the CMS fact sheet on the final rule here​
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