Centers for Medicare & Medicaid Services (CMS) Notice of Change to Reimbursement System for SNF and Home Health

There are important changes to the Centers for Medicare and Medicaid Services (CMS) Notice of Change to Reimbursement System for SNF and Home Health. Effective 10/1/2019, CMS will transition Skilled Nursing Facilities (SNF) from Resource Utilization Group (RUG) to Patient Driven Payment Model (PDPM). Home Health will transition from Prospective Payment System (PPS) to Patient Driven Groupings Model (PDGM) effective 1/1/2020.

CMS has published an article that provides CMS guidance to Medicare providers to help them. This CMS article pertains to all Medicare physicians, providers, and suppliers, including those serving beneficiaries, enrolled in Original Medicare or a Medicare Advantage (MA) plan.

Please review the CMS guidance information for SNF PDPM  as soon as possible

Please review the CMS guidance information for Home Health PDGM payment model  as soon as possible

Overview of the PDGM Model Medicare Learning Network Call – February 12, 2019

• The presentation , audio recording , and transcript  are available from the February 12 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.