Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1737-F] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the value-based purchasing program for skilled nursing facilities (SNFs).
Effective October 1, 2020 under the PPS Patient- Driven Payment Model (PDPM).
Federal Based Rates
- Updates to Payment Rates Under PPS
- Case-mix classification code mapping
- Wage Index Updates
- Updates to the Value-Based Purchasing
SNF Level of Care
- Administrative Presumption
- Consolidated Billing
- Payment for SNF- Level- Swing-Bed Services
- Revisions to the Regulation Text
- Updates to Payment Rates Under PPS
- Case-mix classification code mapping
- Wage Index Updates
- Updates to the Value-Based Purchasing
Technical updates to PDPM ICD-10 Mapping
Click here to view the CMS Federal Register for the final rule.
Click here to view a PDPM rate calculator to compute your individual facility PDPM FY 2021 rates.
Updates to payment rates:
| Table 3: FY 2021 Unadjusted Federal Rate Per Diem- URBAN | ||||||
| Rate Component | PT | OT | SLP | Nursing | NTA | Non-Case-Mix |
| Per Diem Amount | $ 62.04 | $ 57.75 | $ 23.16 | $ 108.16 | $ 81.60 | $ 96.85 |
| Table 4: FY 2021 Unadjusted Federal Rate Per Diem-Rural | ||||||
| Rate Component | PT | OT | SLP | Nursing | NTA | Non-Case-Mix |
| Per Diem Amount | $ 70.72 | $ 64.95 | $ 29.18 | $ 103.34 | $ 77.96 | $ 98.64 |
Case-Mix Classification Code Mapping:
Table 5: PDPM Case-Mix Adjusted Federal Rates and Associated Indexes -URBAN
| PFPM | PT | PT | OT | OT | SLP | SLP | Nursing | Nursing | Nursing | NTA | NTA |
| Group | CMI | Rate | CMI | Rate | CMI | Rate | CMG | CMI | Rate | CMI | Rate |
| A | 1.53 | 94.92 | 1.49 | 86.05 | 0.68 | 15.75 | ES3 | 4.06 | 439.13 | 3.24 | 264.38 |
| B | 1.7 | 105.47 | 1.63 | 94.13 | 1.82 | 42.15 | ES2 | 3.07 | 332.05 | 2.53 | 206.45 |
| C | 1.88 | 116.64 | 1.69 | 97.6 | 2.67 | 61.84 | ES1 | 2.93 | 316.91 | 1.84 | 150.14 |
| D | 1.92 | 119.12 | 1.53 | 88.36 | 1.46 | 33.81 | HDE2 | 2.4 | 259.58 | 1.33 | 108.53 |
| E | 1.42 | 88.1 | 1.41 | 81.43 | 2.34 | 54.19 | HDE1 | 1.99 | 215.24 | 0.96 | 78.34 |
| F | 1.61 | 99.88 | 1.6 | 92.4 | 2.98 | 69.02 | HBC2 | 2.24 | 242.28 | 0.72 | 58.75 |
| G | 1.67 | 103.61 | 1.64 | 94.71 | 2.04 | 47.25 | HBC1 | 1.86 | 201.18 | ||
| H | 1.16 | 71.97 | 1.15 | 66.41 | 2.86 | 66.24 | LDE2 | 2.08 | 224.97 | ||
| I | 1.13 | 70.11 | 1.18 | 68.15 | 3.53 | 81.75 | LDE1 | 1.73 | 187.12 | ||
| J | 1.42 | 88.1 | 1.45 | 83.74 | 2.99 | 69.25 | LBC2 | 1.72 | 186.04 | ||
| K | 1.52 | 94.3 | 1.54 | 88.94 | 3.7 | 85.69 | LBC1 | 1.43 | 154.67 | ||
| L | 1.09 | 67.62 | 1.11 | 64.1 | 4.21 | 97.5 | CDE2 | 1.87 | 202.26 | ||
| M | 1.27 | 78.79 | 1.3 | 75.08 | CDE1 | 1.62 | 175.22 | ||||
| N | 1.48 | 91.82 | 1.5 | 86.63 | CBC2 | 1.55 | 167.65 | ||||
| O | 1.55 | 96.16 | 1.55 | 89.51 | CA2 | 1.09 | 117.89 | ||||
| P | 1.08 | 67 | 1.09 | 62.95 | CBC1 | 1.34 | 144.93 | ||||
| Q | CA1 | 0.94 | 101.67 | ||||||||
| R | BAB2 | 1.04 | 112.49 | ||||||||
| S | BAB1 | 0.99 | 107.08 | ||||||||
| T | PDE2 | 1.57 | 169.81 | ||||||||
| U | PDE1 | 1.47 | 159 | ||||||||
| V | PBC2 | 1.22 | 131.96 | ||||||||
| W | PA2 | 0.71 | 76.79 | ||||||||
| X | PBC1 | 1.13 | 122.22 | ||||||||
| Y | PA1 | 0.66 | 71.39 | ||||||||
| Z | |||||||||||
Case-Mix Classification Code Mapping Rural:
Table 6: PDPM Case-Mix Adjusted Federal Rates and Associated Indexes-RURUAL
| PFPM | PT | PT | OT | OT | SLP | SLP | Nursing | Nursing | Nursing | NTA | NTA |
| Group | CMI | Rate | CMI | Rate | CMI | Rate | CMG | CMI | Rate | CMI | Rate |
| A | 1.53 | 108.2 | 1.49 | 96.78 | 0.68 | 19.84 | ES3 | 4.06 | 419.56 | 3.24 | 252.59 |
| B | 1.7 | 120.22 | 1.63 | 105.87 | 1.82 | 53.11 | ES2 | 3.07 | 317.25 | 2.53 | 197.24 |
| C | 1.88 | 132.95 | 1.69 | 109.77 | 2.67 | 77.91 | ES1 | 2.93 | 302.79 | 1.84 | 143.45 |
| D | 1.92 | 135.78 | 1.53 | 99.37 | 1.46 | 42.6 | HDE2 | 2.4 | 248.02 | 1.33 | 103.69 |
| E | 1.42 | 100.42 | 1.41 | 91.58 | 2.34 | 68.28 | HDE1 | 1.99 | 205.65 | 0.96 | 74.84 |
| F | 1.61 | 113.86 | 1.6 | 103.92 | 2.98 | 86.96 | HBC2 | 2.24 | 231.48 | 0.72 | 56.13 |
| G | 1.67 | 118.1 | 1.64 | 106.52 | 2.04 | 59.53 | HBC1 | 1.86 | 192.21 | ||
| H | 1.16 | 82.04 | 1.15 | 74.69 | 2.86 | 83.45 | LDE2 | 2.08 | 214.95 | ||
| I | 1.13 | 79.91 | 1.18 | 76.64 | 3.53 | 103.01 | LDE1 | 1.73 | 178.78 | ||
| J | 1.42 | 100.42 | 1.45 | 94.18 | 2.99 | 87.25 | LBC2 | 1.72 | 177.74 | ||
| K | 1.52 | 107.49 | 1.54 | 100.02 | 3.7 | 107.97 | LBC1 | 1.43 | 147.78 | ||
| L | 1.09 | 77.08 | 1.11 | 72.09 | 4.21 | 122.85 | CDE2 | 1.87 | 193.25 | ||
| M | 1.27 | 89.81 | 1.3 | 84.44 | CDE1 | 1.62 | 167.41 | ||||
| N | 1.48 | 104.67 | 1.5 | 97.43 | CBC2 | 1.55 | 160.18 | ||||
| O | 1.55 | 109.62 | 1.55 | 100.67 | CA2 | 1.09 | 112.64 | ||||
| P | 1.08 | 76.38 | 1.09 | 70.8 | CBC1 | 1.34 | 138.48 | ||||
| Q | CA1 | 0.94 | 97.14 | ||||||||
| R | BAB2 | 1.04 | 107.47 | ||||||||
| S | BAB1 | 0.99 | 102.31 | ||||||||
| T | PDE2 | 1.57 | 162.24 | ||||||||
| U | PDE1 | 1.47 | 151.91 | ||||||||
| V | PBC2 | 1.22 | 126.07 | ||||||||
| W | PA2 | 0.71 | 73.37 | ||||||||
| X | PBC1 | 1.13 | 116.77 | ||||||||
| Y | PA1 | 0.66 | 68.2 | ||||||||
| Z | |||||||||||
If you would like additional information or further discussion on how this impacts your organization, please contact your local Blue & Co. advisor.
