Under pdpm there are five case mix components.
Therapy component rug rate.
Mds items g october 2014 page g 8 g0110.
Activities of daily living adl assistance cont adl self performance algorithm start here remember to review the instructions for the rule of 3 and the adl self.
Nursing case mix adjusted 181 44 173 34 therapy case mix adjusted 136 67 157 60 therapy non case mix adjusted 18 00 19 23 non case mix adjusted 92 60 94 31.
On july 31 2018 the fiscal year 2019 fy19 medicare skilled nursing facility snf final rule was released by the centers for medicare and medicaid services cms.
Under the old system rug iv there were two case mix adjusted components.
You can use it to view your facility s rates.
The 2020 snf pdpm rate calculator is now available.
Rug assignments weights are applied at the individual level but the average relative risk of a facility s residents is typically used to adjust the nursing components of state medicaid payment systems one exception.
Cms s rai version 3 0 manual ch 3.
In rural facilities the nursing component base rate is 167 45 the therapy component is 152 24 and the other component is 91 11.
Unadjusted federal rates per diem rate component rug iv urban rural.
Physical therapy pt occupational therapy ot speech therapy st nursing and non therapy ancillary nta.
Beginning day 4 through the remainder of the stay the nta component receives 100 of the base per diem rate.
Pt and ot components receive 100 of base per diem rate for days 1 20 of a stay.
Therapy provides their minutes nursing works on their adls and the facility gets paid a per diem rate.
You can use it to view your facility s rates.
Daily payments to snfs are determined.
Texas medicaid adjusts the rug 34 relative risk weights to reflect local practice to establish person level payments.
Therapy base rate therapy index rug or rehab non rehab payment rug non case mix therapy component non case mix component nursing base rate nta nursing 43 57.
The nta component is based on the presence of comorbidities and extensive services received.
Therapy based on volume of services or non case mix base rate nursing does not reflect variations in non therapy ancillary use.
Nta component receives 300 of the base per diem rate for days 1 3 of a stay.
All residents are now classified into one of six nta case mix groups and payment for nta services are broken out from nursing services as currently is done under rug iv.
The nta component is also a variable rate and is reduced over the length of stay.
Fy 2020 unadjusted federal rates per diem rate component pdpm urban rural.
