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Patient-Driven Payment Model:
MatrixCare resources to support your preparation

The resources compiled on this page are intended to support your preparation and compliance for implementation of the Patient Driven Payment Model (PDPM). We have highlighted the resources suggested by CMS. However, there are many other resources available to assist your team. We will continue to add resources and references as applicable.

New in our Patient-Driven Payment Model Webinar Series:

“Developing a Successful Facility Action Plan for Patient-Driven Payment Model (PDPM)
& ICD-10-CM”
Tuesday, February 19th  |  2:00 P.M. Eastern Time

Click Here to Register

During this session we will discuss:

  • An overview of the requirements of PDPM
  • The impact of ICD-10-CM codes on reimbursement
  • The importance of clinical documentation
  • Strategies for developing a successful facility action plan

On Demand Recorded Webinar: Get Ready for the Patient Driven Payment Model (PDPM)

In late July, CMS released the Final rule for FY 2019 which “replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019”. Learn how PDPM differs from RUGS-IV and what you need to do in order to be ready for the proposed October 1, 2019 implementation date.

Patient Driven Payment Model

PDPM Resources: CMS

CMS has published a PDPM site that includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation including PDPM Fact Sheets, FAQs, Training Presentations, and PDPM Resources.

Important Highlights:

  • Fact Sheets > MDS Changes
    • Page 3, New MDS Item Sets: IPA and OSA
    • Page 3, New MDS Item: Section I: SNF Primary Diagnosis
    • Page 3, New MDS Items: Section J: Patient Surgical History
    • Page 5, New MDS Item: Section GG: Interim Performance
  • PDPM Frequently Asked Questions > PDPM FAQs
    • Page 34, Section 14: Transition Policy and Medicaid Issues2: How will I get a PDPM payment code to bill starting October 1, 2019?
  • PDPM Resources > PDPM Classification Walkthrough
    • New version of the document that defines each portion of the PDPM calculation

Draft version of 2019 MDS Item Sets Now Available

CMS has posted a new DRAFT version of the 2019 MDS item sets (v1.17.0). This version is scheduled to become effective October 1, 2019. There are a large number of changes that are outlined for what is coming.

Changes include:

  • First look at the Interim Payment (IPA) and Optional State Assessment (OSA) forms.
  • The only response values for A0310B are:
    • 5-day
    • IPA
    • Not PPS Assessment (None of the above)
  • The OSA form has added a new question: A0300B- Assessment type. Responses include:
    • Start of therapy assessment.
    • End of therapy assessment
    • Both Start and End of therapy assessment
    • Change of therapy assessment
    • Other payment assessment
  • Question I0020, answer value 14, Other Medical Condition has been deleted and the associated diagnosis code I0020A has also been deleted, replaced by I0020B.

Visit CMS website to download MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019 Release.


American Association of Nurse Assessment Coordination (AANAC)

MatrixCare is proud to partner with American Association of Nurse Assessment Coordinators (AANAC) in providing you easy access to their publicly available PDPM content. Founded in 1999, AANAC has earned the reputation as the premier resource and network for long-term care professionals involved in the RAI/MDS process. AANAC is known for their excellent resources in all aspects of information regarding long-term care resident assessment and care planning.

Please visit AANAC to learn more.