PDPM - The Patient Driven Payment Model

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NASL 2020 Issue Briefs:

NASL 2020 Legislative Priorities and Fact Sheet

2021 Cuts to Medicare Part B Programs Reduce Beneficiaries’ Access to Care

LTPAC Health IT Essential To Achieving Efficient, Effective Healthcare System


Benefits of a New Payment Model for Clinical Laboratory Services Provided to Nursing Home or Homebound Patients

Novitas Reimbursement Reduction Poses Huge Risk for Medicare Beneficiaries and Suppliers of Portable X-Ray Services

Hospital Observation Status Harms Beneficiaries’ Access to Medicare’s Skilled Nursing Benefit

Expand Telehealth Services for Medicare Beneficiaries



The Patient Driven Payment Model (PDPM) is the new reimbursement system
model that Medicare will use to determine payments for SNFs starting on
October 1, 2019. PDPM replaces the current Resources Utilization Groups (RUGs)
model.  PDPM fits into a broader push by CMS toward “patient-centered”
reimbursement models that match payment rates to the patients’ needs.

PDPM Resources:


CMS’ Patient Driven Payment Model webpage, containing CMS’ latest documents on PDPM: 
Fact Sheets, FAQs, Training Presentation, Beta version of the Grouper, and ICD-10 Mappings.


PDPM – What is Changing and What is Not?
Presentation by John Kane of CMS to NASL 2019 Winter Conference


How Nursing Homes are Preparing for PDPM
Presentation by Gov. Mark Parkinson of AHCA to NASL 2019 Winter Conference


NASL Questions on PDPM, and CMS Responses  (2018)

RUGs-IV to PDPM – Policy, Data, IT, Assessment, Compliance & Therapy Insights
Panel Presentation to the NASL 29th Annual Meeting (2018)

Panelists:  Jane Moffett, Casamba; Shawn Halcsik, Encore Rehabilitation; John Harned, BKD CPAs & Advisors; Hannah Patterson, Netsmart Technologies;
Judi Kulus, American Association of Nurse Assessment Coordination; Marc Zimmet, Zimmet Healthcare Services Group, LLC


Cognitive Based Care:  IMPACT of Outcomes, PDPM and EBP
Presentation by Renee Kinder of Encore Rehabilitation Services to the
NASL 29th Annual Meeting (2018)


Medicare Part A SNF Prospective Payment System – MDS 3.0 Captured Services as Qualifiers for Medicare Part A RUG-IV Grouper
Distributed at the NASL 29th Annual Meeting (2018)


NASL PDPM Issues and Concerns for Meeting with CMS  (2018)


FY2019 SNF PPS Proposed Rule & the Patient Driven Payment Model
​NASL Webinar presented by Cynthia Morton of NASL on May 22, 2018


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