CMS Updates PDPM Resources

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS posted updated PDPM resources on Friday afternoon, August 30, 2019.

Five (5) Fact Sheets were updated and are now found in .zip format.  Once you open a file, select the redline version to see what’s different (thank you CMS – much appreciated):

Group therapy is (now) defined for Part A as the treatment of 2-6 residents, regardless of payer source, who are performing the same or similar activities, and are supervised by a therapist or an assistant who is not supervising any other individuals.

In cases where neither the BIMS nor the staff assessment is completed, the patient will be considered “cognitively intact” for classification purposes under PDPM.  (Additional information is provided in section 5.4 of the FAQ document.  See below.)

Lots of changes here (also review the updated FAQ document for this area as well).  Review this information carefully as there is a bit more clarification provided.

Mainly a clean-up of verbiage related to the OSA (Optional State Assessment).  CMS has removed this sentence: The optional assessment will be in place from October 1, 2019 through September 30, 2020.  What’s not said with this strike-out is that the OSA Item Set will be extended and available for use beyond October 2020 to allow case-mix states more time to develop Medicaid reimbursement strategies.

Updates reflect the revised case mix weights published in the Final Rule.

The PDPM FAQ document was updated as were the PDPM ICD-10 Mapping spreadsheets (more codes added to the Clinical and NTA spreadsheets).

The FAQ document was also provided in 2 versions within that .zip file.  Review the redline version to see what’s been added and/or changed (watch for cross-outs). You’ll see a lot of red in the Table of Contents.  Many of the additions and changes are expected, based on recent CMS communication with providers.  For example, note the update to PDPM classification when neither a BIMS nor staff assessment is completed:


Interrupted Stay information also sees a lot of red ink so be sure to check that out.

“Any questions regarding the OSA should be directed to the relevant state agency governing the state’s Medicaid policy issues.”

October 1st is 26 days from today.  Take the time to review these updated documents and make sure your team is aware of the clarifications!