What Is PDPM?

The Centers for Medicare and Medicaid Services (CMS) will soon be replacing the Resource Utilization Group (RUG) Version IV payment model with the new Patient Driven Payment Model (PDPM).

The current RUG-IV system focused on payments based on how much therapy services were received. However, PDPM places patients into case-mix groups based on certain clinical characteristics.

This article from @SIAResearch does a fantastic job detailing out what this new model will look like and what Skilled Nursing Facilities (SNF’s) should expect.

CMS Requested To Simplify Three-Day Stay Rule

Currently, Medicare beneficiaries must have a three-day hospital stay to receive subsequent fully covered skilled nursing services. Hospitals admitting on an observation basis rather than inpatient has lead to very costly Medicare denials.

The American Health Care Association (AHCA) CEO has asked Centers for Medicare & Medicaid Services (CMS) to eliminate uncertainty on the Medicare three-day stay rule stating, “three days is three days”.

For more on this, see this article from @skilled_nursing.

SNFs Looking To Improve Payer Relationships

Skilled Nursing Facilities are experiencing the necessity of a positive Payer relationship.
Medicare Advantage plans are focusing on strategies that will have the greatest impact, affecting the most lives.
To succeed, SNFs must learn to identify a Payer’s top priorities and build a solid foundation of communication, ensuring both parties are on the same page with data as this is often a source of conflict.

For more on this please see the article below.

Iowa’s Medicaid Director’s Belief In Managed Care Undaunted By Cost Increase

Payments have increased to the two Iowa managed care companies being paid to run the program this year. However, Iowa’s Medicaid Director notes that this should not be referred to as a raise, but as necessary due to rising costs the companies face as well as reflecting the increased payments legislator’s have determined for nursing homes and rural hospitals.

The Medicaid Director believes that taxpayers are actually saving money with the program being run by private companies rather than the state.

For more on this, see the @DMRegister article below.

Long-Term Managed Medicaid Could Disappear In NY

There is currently a New York state waiver amendment that would remove long-term managed Medicaid for patients living in SNFs. If approved, this would transition back into a fee-for-service Medicaid for stays over three months and would be implemented at the beginning of 2020. Other states could look to similar strategies as most states are known to currently be keeping a close eye on the state of New York. Such a change would be a major shift in the industry as Medicaid forms the bulk of most nursing facility payments. For more on this please see the @skilled_nursing article below.