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Skilled Nursing Facilities PPS FY 2021 Final Rule Summary

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 ComponentPTOTSLPNursingNTANon-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 ComponentPTOTSLPNursingNTANon-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 PTPTOTOTSLPSLPNursingNursingNursingNTANTA
GroupCMIRateCMIRateCMIRateCMGCMIRateCMIRate
A1.5394.921.4986.050.6815.75ES34.06439.133.24264.38
B1.7105.471.6394.131.8242.15ES23.07332.052.53206.45
C1.88116.641.6997.62.6761.84ES12.93316.911.84150.14
D1.92119.121.5388.361.4633.81HDE22.4259.581.33108.53
E1.4288.11.4181.432.3454.19HDE11.99215.240.9678.34
F1.6199.881.692.42.9869.02HBC22.24242.280.7258.75
G1.67103.611.6494.712.0447.25HBC11.86201.18
H1.1671.971.1566.412.8666.24LDE22.08224.97
I1.1370.111.1868.153.5381.75LDE11.73187.12
J1.4288.11.4583.742.9969.25LBC21.72186.04
K1.5294.31.5488.943.785.69LBC11.43154.67
L1.0967.621.1164.14.2197.5CDE21.87202.26
M1.2778.791.375.08CDE11.62175.22
N1.4891.821.586.63CBC21.55167.65
O1.5596.161.5589.51CA21.09117.89
P1.08671.0962.95CBC11.34144.93
QCA10.94101.67
RBAB21.04112.49
SBAB10.99107.08
TPDE21.57169.81
UPDE11.47159
VPBC21.22131.96
WPA20.7176.79
XPBC11.13122.22
YPA10.6671.39
Z

 

Case-Mix Classification Code Mapping Rural:
Table 6: PDPM Case-Mix Adjusted Federal Rates and Associated Indexes-RURUAL

PFPM PTPTOTOTSLPSLPNursingNursingNursingNTANTA
GroupCMIRateCMIRateCMIRateCMGCMIRateCMIRate
A1.53108.21.4996.780.6819.84ES34.06419.563.24252.59
B1.7120.221.63105.871.8253.11ES23.07317.252.53197.24
C1.88132.951.69109.772.6777.91ES12.93302.791.84143.45
D1.92135.781.5399.371.4642.6HDE22.4248.021.33103.69
E1.42100.421.4191.582.3468.28HDE11.99205.650.9674.84
F1.61113.861.6103.922.9886.96HBC22.24231.480.7256.13
G1.67118.11.64106.522.0459.53HBC11.86192.21
H1.1682.041.1574.692.8683.45LDE22.08214.95
I1.1379.911.1876.643.53103.01LDE11.73178.78
J1.42100.421.4594.182.9987.25LBC21.72177.74
K1.52107.491.54100.023.7107.97LBC11.43147.78
L1.0977.081.1172.094.21122.85CDE21.87193.25
M1.2789.811.384.44CDE11.62167.41
N1.48104.671.597.43CBC21.55160.18
O1.55109.621.55100.67CA21.09112.64
P1.0876.381.0970.8CBC11.34138.48
QCA10.9497.14
RBAB21.04107.47
SBAB10.99102.31
TPDE21.57162.24
UPDE11.47151.91
VPBC21.22126.07
WPA20.7173.37
XPBC11.13116.77
YPA10.6668.2
Z

 

Download Wage Indexes Here

If you would like additional information or further discussion on how this impacts your organization, please contact your local Blue & Co. advisor. 

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