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PDPM Is Here!

On October 1st, the Patient-Driven Payment Model (PDPM) became the Medicare Part A fee-for-service payment system for Skilled Nursing Facilities. PDPM replaced the Resource Utilization Group IV (RUG IV) payment system in its entirety with no transition period. If you have not done so already, now is the time to make sure your contracts are up-to-date and appropriate with all payers impacted by PDPM, including Medicare Advantage, the U.S. Department of Veterans Affairs (VA), and TRICARE. It is important that your legal counsel also reads any contracts closely before entering into them, particularly with the VA.

Each week, the American Health Care Association (AHCA) will collect feedback on PDPM implementation. Please help provide valuable, real-time information by completing this survey each week. This will help us address your needs through member education, resources, and advocacy with the Centers for Medicare and Medicaid Services (CMS) on regional or national issues.

PDPM Resource Navigators

AHCA PDPM Resource Navigators are trained to help you find existing AHCA and CMS resources and guidance. They can be reached by email at or by calling (202)-842-4444 and asking to speak with an AHCA PDPM Resource Navigator. If you have technical questions, PDPM Resource Navigators will record your information and question(s) and submit them to in-house PDPM technical experts. Members will receive a same day response to questions and requests. You will be notified if additional technical research or clarification from CMS is required, and a projected response date will be provided.

Available Resources

AHCA PDPM Resource Navigators can help you find existing AHCA resources, such as those offered on ahcancalED. While many of the AHCA PDPM resources are available to all members, some are available only to participants of the PDPM Academy. The PDPM Resource Center for all members is available here, while resources for AHCA PDPM Academy registrants are available here. CMS also offers numerous resources in which the AHCA PDPM Resource Navigators can assist, such as the ICD-10 NTA Mapping Guide and a video on PDPM and the Agency’s priorities.