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Need-to-know facts about Medicare's proposed reimbursement system.

Updated: Jun 23, 2018

The Patient-Driven Payment Method (PDPM) is CMS’ proposed reimbursement system for Medicare Part A recipients.




If this system goes into effect as proposed in October 2019, skilled nursing providers will be required to categorize residents across five categories, including two nursing case mixes (nursing and non-therapy ancillary) and one each for physical therapy, occupational therapy, and speech-language pathology.



Regardless of whether a resident receives a certain therapy type, he or she would be rated in that category to create an aggregate mix and determine the corresponding reimbursement rate. The proposed model also trims PT, OT and non-therapy ancillary pay over specific periods, while pay for speech language and nursing services would hold steady throughout a stay.





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