Patient-Driven Payment Model (PDPM): At-a-Glance

1 1 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination. All Rights Reserved. Payment Model (PDPM): At-a-GlanceThe proposed PDPM establishes a rate on the 5-day MDS for the entire stay by combining five different case-mix components (PT, OT, SLP, Nursing, and Non-Therapy Ancillary) with the non-case-mix component. The rate may be changed during the Medicare Part A stay by completing the Interim Payment Assessment (IPA) for substantial the following At-a-Glance tools to identify the case-mix group for each component and improve your understanding of the proposed Patient-Driven Payment : This document is intended to aid members in their review of the Patient-Driven Payment Model .

2 Resources: FY 2019 SNF PPS Proposed Rulemaking and CMS draft PDPM Calculation Worksheet for SNFs. All information regarding PDPM is subject to change pending final rulemaking. AANAC has made every attempt to ensure the accuracy and reliability of the information provided. AANAC does not accept any responsibility or liability for the accuracy, content, and completeness of the Case-Mix GroupOT Case-Mix GroupSLP Case-Mix GroupNursing Case-Mix GroupNon-Therapy Ancillary Case-Mix GroupNon-Case-Mix ComponentResident s Total RateProposed Patient-Driven Payment Model : At-a-Glance2 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination.

3 All Rights Reserved. Component and OT Component*Scoring Response for Section GG ItemsScore 05, 06 Set-up assistance, independent404 Supervision or touching assistance303 Partial/moderate assistance202 Substantial/maximal assistance101, 07, 09, 88 Dependent, refused, not attempted0 Section GG items Score GG0130A1 Self-care: Eating 0 4GG0130B1 Self-care: Oral hygiene0 4GG0130C1 Self-care: Toileting hygiene 0 4GG0170B1 Mobility: Sit to lying0 4 (avg. of 2 bed mobility items) GG0170C1 Mobility: Lying to sitting on side of bed GG0170D1 Mobility: Sit to stand0 4 (avg.)

4 Of 3 transfer items)GG0170E1 Mobility: Chair/bed-to-chair transferGG0170F1 Mobility: Toilet transferGG0170J1 Mobility: Walk 50 feet with 2 turns0 4 (avg. of 2 walking items)GG0170K1 Mobility: Walk 150 feetTATBTCTDM ajor Joint Replacement or Spinal Surgery6 910 23240 56 910 23240 56 910 23240 56 910 23240 5 TETFTGTHO ther OrthopedicTITJTKTLM edical ManagementTMTNTOTPNon-Orthopedic Surgery and Acute NeurologicClinical CategoryPT and OT Case-Mix GroupGG Function ScoreNOTE: This document is intended to aid members in their review of the Patient-Driven Payment Model .

5 Resources: FY 2019 SNF PPS Proposed Rulemaking and CMS draft PDPM Calculation Worksheet for SNFs. All information regarding PDPM is subject to change pending final rulemaking. AANAC has made every attempt to ensure the accuracy and reliability of the information provided. AANAC does not accept any responsibility or liability for the accuracy, content, and completeness of the Component and OT Component: PT and OT components will always result in the same case-mix group; however, the PT and OT case-mix indices/ Payment levels Patient-Driven Payment Model : At-a-Glance3 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination.

6 All Rights Reserved. ComponentNOTE: This document is intended to aid members in their review of the Patient-Driven Payment Model . Resources: FY 2019 SNF PPS Proposed Rulemaking and CMS draft PDPM Calculation Worksheet for SNFs. All information regarding PDPM is subject to change pending final rulemaking. AANAC has made every attempt to ensure the accuracy and reliability of the information provided. AANAC does not accept any responsibility or liability for the accuracy, content, and completeness of the Comorbidities:Aphasia (I4300); CVA, TIA, or Stroke (I4500); Hemiplegia or Hemiparesis (I4900); TBI (I5500); Tracheostomy (O0100E2); Ventilator (I0100F2).

7 Laryngeal Cancer, Apraxia, Dysphagia, ALS, Oral Cancers, Speech and Language Deficits (I8000)NeitherSDEitherSEBothSFAny oneNeitherSGEitherSHBothSIAny twoNeitherSJEitherSKBothSLAll threeNeitherEitherBothSASBSCNonePresence of Acute Neurologic Condition, SLP-Related Comorbidity*, or Cognitive Impairment**Presence of: Swallowing Disorder (K0100A D) OR Mechanically Altered Diet (K0510C2)SLP Case-Mix GroupCognitive Impairment:The PDPM cognitive level is based on the Brief Interview for Mental Status (BIMS) or staff assessment. See the PDPM calculation worksheet provided by CMS for Patient-Driven Payment Model : At-a-Glance4 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination.

8 All Rights Reserved. Component*NOTE: This document is intended to aid members in their review of the Patient-Driven Payment Model . Resources: FY 2019 SNF PPS Proposed Rulemaking and CMS draft PDPM Calculation Worksheet for SNFs. All information regarding PDPM is subject to change pending final rulemaking. AANAC has made every attempt to ensure the accuracy and reliability of the information provided. AANAC does not accept any responsibility or liability for the accuracy, content, and completeness of the CLINICALLY COMPLEXYES2 DEPRESSED ADL0-56-1415-16 CDE2 CBC2 CA21 NOT DEPRESSED ADL0-56-1415-16 CDE1 CBC1 CA1 YES2 NURSING REHAB 2+ ADL0-56-1415-16 PDE2 PBC2 PA 21 NURSING REHAB 0-1 ADL0-56-1415-16 PDE1 PBC1 PA 1 REDUCED PHYSICAL FUNCTION BEHAVIOR SX COGNITION11-16 BAB211-16 BAB1 YES2 NURSING REHAB 2+1 NURSING REHAB 0-1 SPECIAL CARE HIGH0-56-14 HDE2 HBC20-56-14 HDE1 HBC1 YES2 DEPRESSED1 NOT DEPRESSED ADL ADL SPECIAL CARE LOW0-56-14 LDE2 LBC20-56-14 LDE1 LBC1 YES2 DEPRESSED1 NOT DEPRESSED ADL

9 ADLNONONONONO EXTENSIVE SERVICESYES ES3 ES2 ES13 TRACHEOSTOMY & VENTILATOR2 TRACHEOSTOMY OR VENTILATOR1 INFECTION ISOLATION0-140-140-14GG-based Function ScoreScoring Response for Section GG ItemsScore 05, 06 Set-up assistance, independent404 Supervision or touching assistance303 Partial/moderate assistance202 Substantial/maximal assistance101, 07, 09, 88 Dependent, refused, not attempted0 Section GG items Score GG0130A1 Self-care: Eating 0 4GG0130C1 Self-care: Toileting hygiene 0 4GG0170B1 Mobility: Sit to lying0 4 (avg. of 2 bed mobility items) GG0170C1 Mobility: Lying to sitting on side of bed GG0170D1 Mobility: Sit to stand0 4 (avg.)

10 Of 3 transfer items)GG0170E1 Mobility: Chair/bed-to-chair transferGG0170F1 Mobility: Toilet transferNursing Component: See the CMS PDPM calculation worksheet for inclusion criteria for each nursing Patient-Driven Payment Model : At-a-Glance5 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination. All Rights Reserved. Ancillary (NTA) ComponentNOTE: This document is intended to aid members in their review of the Patient-Driven Payment Model . Resources: FY 2019 SNF PPS Proposed Rulemaking and CMS draft PDPM Calculation Worksheet for SNFs.