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FY 2021 Medicare Part A Final Rule Summary

The Patient-Driven Payment Model (PDPM) turns one year old on Oct. 1, 2020. In the fall of 2019, the methodology replaced Resource Utilization Group (RUG)-IV as the basis for nursing home Medicare Part A rates, shifting the focus of reimbursement away from the minutes of therapy provided and toward resident characteristics that have been shown to be predictive of care needs. The Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule updates payment amounts and makes some minor policy changes to nursing home reimbursement and the Value-Based Purchasing (VBP) program that are described in a new LeadingAge NY memo. The memo also provides a listing of the Fiscal Year (FY) 2021 PDPM rates, along with rate tables and calculators for homes in New York State. To access the memo, click here.

Contacts: for VBP/Quality Reporting Program (QRP) provisions: Dan Heim, dheim@leadingageny.org; for rate calculation issues: Darius Kirstein, dkirstein@leadingageny.org