On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled therapy.
The Center for Medicare Advocacy (the Center) and the Long Term Care Community Coalition (LTCCC) have developed a new Issue Alert to help residents and their families understand the implications of PDPM as it relates to Medicare-covered skilled therapy services in nursing homes. The Issue Alert also provides information about relevant federal standards of care to help residents and families in preventing and challenging skilled therapy denials.