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 . 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.

2 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. 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.)

3 Of 2 bed mobility items) GG0170C1 mobility : Lying to sitting on side of bed GG0170D1 mobility : Sit to stand0 4 (avg. 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 . 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.

4 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. 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); 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.

5 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. 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 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.

6 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. 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 .

7 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 Score RangeNTA Case-Mix Group12+NA9 11NB6 8NC3 5ND1 2NE0NF** High level: K0710A2 = 3. 51% or more (while a resident)** Low level: K0710A2 = 2. 26 50% (while a resident) and K0710B2 = 2. 501cc/day or more (while a resident)Condition/Extensive Service Source Points HIV/AIDSSNF Claim8 Parenteral IV Feeding: Level HighMDS Item K0510A2, K0710A27 Special Treatments/Programs: Intravenous Medication Post-admit CodeMDS Item O0100H25 Special Treatments/Programs: Ventilator or Respirator Post-admit CodeMDS Item O0100F24 Parenteral IV Feeding: Level LowMDS Item K0510A2, K0710A2, K0710B23 Lung Transplant StatusMDS Item I80003 Special Treatments/Programs: Transfusion Post-admit CodeMDS Item O0100I22 Major Organ Transplant Status, Except LungMDS Item I80002 Active Diagnoses: Multiple Sclerosis CodeMDS Item I52002 Opportunistic InfectionsMDS Item I80002 Active Diagnoses.

8 Asthma COPD Chronic Lung Disease CodeMDS Item I62002 Bone/Joint/Muscle Infections/Necrosis Except Aseptic Necrosis of BoneMDS Item I80002 Chronic Myeloid LeukemiaMDS Item I80002 Wound Infection CodeMDS Item I25002 Active Diagnoses: Diabetes Mellitus (DM) CodeMDS Item I29002 EndocarditisMDS Item I80001 Immune DisordersMDS Item I80001 End-Stage Liver DiseaseMDS Item I80001 Other Foot Skin Problems: Diabetic Foot Ulcer CodeMDS Item M1040B1 Narcolepsy and CataplexyMDS Item I80001 Cystic FibrosisMDS Item I80001 Special Treatments/Programs: Tracheostomy Care Post-admit CodeMDS Item O0100E21 Active Diagnoses: Multi-Drug Resistant Organism (MDRO) CodeMDS Item I17001 Special Treatments/Programs: Isolation Post-admit CodeMDS Item O0100M21 Specified Hereditary Metabolic/Immune DisordersMDS Item I80001 Morbid ObesityMDS Item I80001 ContinuedProposed Patient-Driven Payment Model : At-a-Glance6 Copyright 1520, American Association of Post-Acute Care Nursing, d/b/a American Association of Nurse Assessment Coordination.

9 All Rights Reserved. Ancillary (NTA) Component (Continued)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 Service Source Points Special Treatments/Programs: Radiation Post-admit CodeMDS Item O0100B21 Highest Stage of Unhealed Pressure Ulcer Stage 4 MDS Item M0300D11 Psoriatic Arthropathy and Systemic SclerosisMDS Item I80001 Chronic PancreatitisMDS Item I80001 Proliferative Diabetic Retinopathy and Vitreous HemorrhageMDS Item I80001 Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code (M1040B)MDS Item M1040A, M1040C1 Complications of Specified Implanted Device or GraftMDS Item I80001 Bladder and Bowel Appliances: Intermittent CatheterizationMDS Item H0100D1 Inflammatory Bowel DiseaseMDS Item I80001 Aseptic Necrosis of BoneMDS Item I80001 Special Treatments/Programs.

10 Suctioning Post-admit CodeMDS Item O0100D21 Cardio-Respiratory Failure and ShockMDS Item I80001 Myelodysplastic Syndromes and MyelofibrosisMDS Item I80001 Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory SpondylopathiesMDS Item I80001 Diabetic Retinopathy Except Proliferative Diabetic Retinopathy and Vitreous HemorrhageMDS Item I80001 Nutritional Approaches While a Resident: Feeding TubeMDS Item K0510B21 Severe Skin Burn or ConditionMDS Item I80001 Intractable EpilepsyMDS Item I80001 Active Diagnoses: Malnutrition CodeMDS Item I56001 Disorders of Immunity Except: RxCC97: Immune DisordersMDS Item I80001 Cirrhosis of LiverMDS Item I80001 Bladder and Bowel Appliances: OstomyMDS Item H0100C1 Respiratory ArrestMDS Item I80001 Pulmonary Fibrosis and Other Chronic Lung DisordersMDS Item I80001 NTA Score RangeNTA Case-Mix Group12+NA9 11NB6 8NC3 5ND1 2NE0NF!