PDPM – AHCA Member Support

Carl J. Pucci and Nancy Leveille and Lisa Volk

Tomorrow, October 1, 2019, PDPM will replace RUGS IV as the Medicare Part A FFS Payment System. AHCA has Resource Navigators trained to respond to PDPM questions as they arise. Below is the AHCA Bulletin which includes various PDPM resource links, as well as phone contact information for technical support.

Members are urged to continuously monitor the AHCA PDPM Resource Center for further updates.

Tomorrow, October 1st, the Patient-Driven Payment Model (PDPM) will become the Medicare Part A fee-for-service payment system for Skilled Nursing Facilities. PDPM replaces the Resource Utilization Group IV (RUG IV) payment system in its entirety with no transition period. If you have not done so already, now is the time to make sure your contracts are up-to-date and appropriate with all payers impacted by PDPM, including Medicaid, Medicare Advantage, the U.S. Department of Veterans Affairs (VA), and TRICARE. It is important that your legal counsel also reads any contracts closely before entering into them, particularly with the VA.

HELP US UNDERSTAND HOW IMPLEMENTATION IS GOING AND YOUR NEEDS

Each week, the American Health Care Association (AHCA) will collect feedback on PDPM implementation. Please help provide valuable, real-time information by completing this survey each week. This will help us address your needs through member education, resources, and advocacy with the Centers for Medicare and Medicaid Services (CMS) on regional or national issues.

AHCA MEMBER SUPPORT

AHCA has worked closely with members over the past year to provide resources and ensure you are prepared for success under the new payment model. These efforts will continue into post-implementation.

PDPM Resource Navigators

AHCA PDPM Resource Navigators are trained to help you find existing AHCA and CMS resources and guidance. They can be reached by email at pdpm@ahca.org or by calling (202)-842-4444 and asking to speak with an AHCA PDPM Resource Navigator. If you have technical questions, PDPM Resource Navigators will record your information and question(s) and submit them to in-house PDPM technical experts. Members will receive a same day response to questions and requests. You will be notified if additional technical research or clarification from CMS is required, and a projected response date will be provided.

Available Resources

AHCA PDPM Resource Navigators can help you find existing AHCA resources, such as those offered on ahcancalED. While many of the AHCA PDPM resources are available to all members, some are available only to participants of the PDPM Academy. The PDPM Resource Center for all members is available here, while resources for AHCA PDPM Academy registrants are available here. CMS also offers numerous resources in which the AHCA PDPM Resource Navigators can assist, such as the ICD-10 NTA Mapping Guide and a video on PDPM and the Agency's priorities.

AHCA offers resources and is prepared to answer PDPM policy and operational questions. If you need intensive, hands-on assistance, such as claims submissions, we can refer you to a vetted consultant.

2020 PDPM ACADEMY

AHCA will provide ongoing support and resources throughout PDPM implementation as CMS makes changes. The 2020 PDPM Academy will provide tools and resources to help Academy members navigate challenges, incorporate changes, and successfully operate under PDPM. Resources will include virtual training modules on CMS PDPM updates, monthly webinars, additional tools/resources, and AHCA analyses of CMS's technical changes and updates to PDPM and easy to use check lists to incorporate changes. To pre-register for the 2020 PDPM Academy or for additional information, please contact the PDPM Resource Navigators or call (202) 842-4444.

AHCA IS HERE TO HELP

AHCA is here to help members be successful under PDPM. We will continue to provide updates, outreach, and resources to assist in this transition and beyond. Be sure to join at us at the 70th AHCA/NCAL Convention & Expo and take advantage of the numerous PDPM education sessions and intensives. 

Please do not hesitate to contact us for any support or questions. We look forward to continuing our work with you throughout PDPM implementation and in the coming months. 

Please email pdpm@ahca.org or call (202) 842-2222 with any questions.

NYSHFA/NYSCAL CONTACTS:

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

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

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15