The Patient Driven Payment Model for SNFs


The finalized Patient Driven Payment Model (PDPM) was released in the SNF PPS FY2019 Final Rule. The PDPM will fundamentally change the way that SNFs are reimbursed for Medicare Part A PPS services. This change will move the industry from a volume-based payment model to a patient characteristic-based one. This course will provide an overview of the new SNF payment model based on the published final rule. This course will discuss the key components on how the SNF PPS daily rate will be calculated, how and when the rate adjustments occur, as well as PPS assessment requirements under this new system.


Hours: 1.00


Certificates provided by accrediting body (9 Match)

American Nurses Credentialing Center


Relias, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Nurses will receive 1.00 contact hours for participating in this course.

California Nursing Home Administrator Program - non-P type


This educational offering is approved by the California Nursing Home Administrator Program (NHAP) for full credit as a course relating directly to duties, functions, or responsibilities of the nursing home administrator. Provider # CEP 1701; Course Approval # 1701001-6826. This activity is approved for 1.00 contact hours.

Tennessee Department of Health


Learning activity approved by the Tennessee Department of Health, Bureau of Health Licensure and Regulation as continuing education for Residential Homes for the Aged and Assisted Care Living Facility administrators. This activity is approved for 1.00 contact hours.

National Association of Long Term Care Administrator Boards (NHA)


This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 1.00 clock hours. If you have any feedback regarding the NAB approved continuing education programs, send your email to the following address: [email protected]
Hours type - NHA: Administrative Hours

Missouri Health Care Association


This on-line activity has been approved for 1.00 Administrative Hour(s) toward the Missouri continuing education requirement for nursing home administrators. Relias LLC offers courses approved by the Missouri Health Care Association, an approved training agency, TA-002-919, by the Missouri Board of Nursing Home Administrators. This activity is approved for 1.00 contact hours.

California Board of Registered Nursing


Provider approved by the California Board of Registered Nursing, CEP# 13791

Nurses will receive 1.00 contact hours for participating in this course.

Georgia Board of Nursing


Georgia Board of Nursing CE Provider #: 50-290

Nurses will receive 1.00 contact hours for participating in this course.

South Carolina Board of Nursing


This program was approved by the South Carolina Board of Nursing Approved Continuing Education Program (CE provider #50-290) CE Broker Course # 20-[Custom_Code]

West Virginia Board of Registered Nursing


Course Details

Course Code: REL-SRC-0-25738
Hours: 1
Type: Online Course
Content Expiration Date: 9/30/2019
Learning Objectives:
Learners will be able to identify the 6 different components of the PDPM rate.
Identify how each PDPM component will be determined.
Identify the SNF PPS required assessments under the PDPM payment system.
Explain the interrupted stay policy and implications.
Explain how PDPM payments will be adjusted during the course of a resident's Medicare Part A stay.
Identify 2-3 operational changes that a SNF may have to consider under the new payment model.


Understanding the Patient Driven Payment Model

Why a New Payment Model?

OIG Reports Over the Years

CMS Goals

Acumen – CMS Contractor

Patient Driven Payment Model (PDPM)

PDPM – 6 Components

Patient Driven Payment Model

Physical and Occupational Therapy Case-Mix Classification

PT and PT Components

4 PT/OT Clinical Categories

PT and OT Function Score

PT and OT Function Score Construction (Except Walking)

PT and OT Function Score Construction for Walking Items

Section GG Items Included in PT and OT Function Measure

PT and OT Case-Mix Classification Groups

Knowledge Check

Speech Language Pathology Case-Mix Classification

SLP Component

SLP-Related Comorbidities

Cognitive Functional Score (CFS)

SLP Component

SLP Case-Mix Classification Groups

Nursing Case-Mix Classification

25 Nursing Indexes

Section GG Items for Nursing

PDPM Nursing Index – 25 Indexes


Knowledge Check

Non-Therapy Ancillary Case-Mix Classification

50 Conditions & Extensive Services Used for NTA Classification

NTA Case-Mix Classification Groups

Non Case-Mix Component

Non Case-Mix Component

Variable Per Diem Adjustment Factor

Variable Per Diem Adjustment Factor

Knowledge Check

MDS Assessments to Be Completed

5-Day Scheduled Assessment

Interim Payment Assessment

PPS Discharge Assessment

Modified Section O

Decrease in Provider Burden

PDMP Modes of Therapy

PDMP Interrupted Stays

PDMP Per Diem

Knowledge Check

Hip Replacement Example

Joint Replacement Medically Complex

Hip Replacement Example

Now What? Industry Changes?

Some Concerns About the Model



Instructor: Mark McDavid, OTR, RAC-CT
Mark McDavid is an occupational therapy graduate from the University of South Alabama and he has also completed Resident Assessment Coordinator (RAC-CT) certification from the American Association of Nurse Assessment Coordinators (AANAC). An experienced leader within the field of allied health services, Mark has a proven track-record of dynamically growing therapy operations for both in-house and contract service companies. After his hire in 2009 to manage all clinical staff and programs for a regional contract therapy company, this twenty-eight-year-old company went on to experience its three most successful years to date. Mark's knowledge and its application to business strategies has earned national recognition within professional organizations, to include conference speaking invitations, appointment to AANAC's Expert Advisory Panel, and election as a board member-at-large for National Association of Rehab Agencies and Providers. He is a sought after source in regards to regulatory compliance, PDPM, MDS, MPPR, manual medical review, functional status coding, and documentation. As the president of Seagrove Rehab Partners, Mark's expertise is now available to a wider audience as he provides training and tailored consulting services to propel companies toward greater prosperity and excellent patient outcomes. Disclosure: Mark McDavid, OTR, RAC-CT has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Nurses; entry level Administrators; in the following settings: Post-Acute Care.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.