CMS Releases MDS 3.0 RAI Manual

PUBLISHED: May 22, 2019
Relevant to: Long Term Care

The US Centers for Medicare and Medicaid Services (CMS) has released the Minimum Data Set (MDS) 3.0 RAI Manual. MDS 3.0 contains many updates, including information related to the Patient Driven Payment Model. CMS advises that this is a preliminary release in response to stakeholder feedback and a final posting containing additional updates will be available prior to the October 1, 2019 effective date.

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), PDPM will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. According to CMS, PDPM improves the overall accuracy and appropriateness of SNF payments by classifying patients into payment groups based on specific, data-driven patient characteristics, while simultaneously reducing administrative burden on SNF providers.

The PDPM classification methodology utilizes a combination of six payment components to derive payment. Five of the components are case-mix adjusted to cover utilization of SNF resources that vary according to patient characteristics. There is also an additional non-case-mix adjusted component to address utilization of SNF resources that do not vary by patient. Different patient characteristics are used to determine a patient’s classification into a case-mix group (CMG) within each of the case-mix adjusted payment components. The payment for each component is calculated by multiplying the case-mix index (CMI) that corresponds to the patient’s CMG by the wage adjusted component base payment rate, then by the specific day in the variable per diem adjustment schedule when applicable. The payments for each component are then added together along with the non-case-mix component payment rate to create a patient's total SNF PPS per diem rate under the PDPM.

CMS has many resources available for long term care facilities as they prepare for the shift to PDPM. Resources includes training, FAQs and the newly released MDS 3.0.

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