Update on CMS’ PDPM Program

Nancy Leveille and Carl Pucci in Clinical & Quality, Finance & Reimbursement

PDPM starts on October 1, 2019. The information below was sent to NYSHFA from AHCA:

On August 30, the Centers for Medicare and Medicaid Services (CMS) updated an array of subregulatory PDPM materials including:

  • PDPM FAQs – Changes in terminology such as 5-Day Assessment now called the Initial Medicare Assessment;
  • Patient Classification – Updates Case Mix Indices based on the Final Rule;
  • Interrupted Stay – Updates the Interrupted Stay Example; • Therapy Group and Concurrent – Updates the Definition of Group to 2 – 6 Residents; and
  • PDPM ICD-10 Mapping – Updates following the Final Rule Changes.

These materials can be viewed here. Please note that the documents which have been updated have a 8/30/2019 date stamp next to them.

Be Prepared

AHCA has resources to help you be prepared for the October 1 implementation of PDPM.

  • Visit ahcancalED to find all our online resources to help you be ready for PDPM on October 1.
  • PDPM training will be a major focus at the 70th AHCA/NCAL Convention and Expo, October 13-16 in Orlando, FL. Education sessions will focus on a variety of topics, including PDPM and the Future of SNF Payment and Organizational Success Under PDPM. Be sure to register today.

Please feel free to email the AHCA PDPM team with any questions, suggestions, or concerns.

Best Regards,

Mike W. Cheek
Senior Vice President
Reimbursement Policy


Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36