This presentation provides an introductory overview of the new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) payment model that will be implemented on October 1, 2019 (Fiscal Year 2020).  Specifically, the current Resource Utilization Groups, version IV (RUG-IV) per-diem case-mix payment model, which is based on resident characteristics and therapy utilization, will be replaced by a Patient Driven Payment Model (PDPM), which is based solely on resident characteristics.  This represents the most significant change in how SNFs are paid since the SNF PPS was first implemented in October 1998.  This presentation describes the motivations for the Centers for Medicare and Medicaid Services (CMS) to change the SNF PPS payment model, the basic design of the PDPM payment model, the specific patient assessment payment drivers and their impacts on payment rates, and the AHCA member support activities to help members prepare for PDPM implementation.

This course contains 6 modules that provide an in-depth description of each feature of the CMS Skilled Nursing Facility Value Based Purchasing (SNF VBP) program along with helpful tools, documents, and primary source references to the program. This course covers how CMS calculates the 1) rehospitalization rates, including risk adjustments, 2) a facility’s performance score, and 3) the resulting incentive payment multiplier, which is used to adjust a facility’s Part A payments.

Modules also provide demonstrations on how to access and interpret CMS feedback reports, like the SNF VBP Performance Score Report containing your incentive payment multiplier information, and AHCA's SNF VBP prediction tool that allows a facility to estimate the financial impact different rehospitalization rates will have on their revenue.