SNF PDPM Daily Rate Calculator
Understanding the PDPM Rate Calculation
The Patient Driven Payment Model (PDPM) is the current reimbursement system for Skilled Nursing Facilities (SNFs) under Medicare Part A. Unlike the previous RUG-IV system, which focused heavily on the volume of therapy services, PDPM focuses on the individual patient's clinical characteristics, needs, and goals.
This calculator helps facility administrators and MDS coordinators estimate the daily reimbursement rate based on the five case-mix components and the fixed non-case mix base.
The Five Components of PDPM
- Physical Therapy (PT): Determined by the patient's clinical category and functional status.
- Occupational Therapy (OT): Calculated similarly to PT, using clinical reasons for admission and functional scores.
- Speech-Language Pathology (SLP): Based on clinical reasons, comorbidities, and the presence of swallowing disorders or cognitive impairments.
- Nursing: Derived from the patient's clinical conditions, extensive services required, or high-acuity nursing needs.
- Non-Therapy Ancillary (NTA): Accounts for the cost of medications and supplies for complex conditions like HIV/AIDS, parenteral feeding, or expensive medications.
Calculation Logic for FY 2024
Each component starts with a Base Rate (either Urban or Rural). This base rate is then multiplied by a Case-Mix Index (CMI), which is the weight assigned to the specific clinical group identified during the MDS assessment. Finally, a non-case-mix base rate is added to cover overhead costs.
Example Calculation: If a patient in an urban facility is classified as PT Group TA (1.53 CMI), the PT portion of the daily rate would be roughly $65.86 × 1.53 = $100.77. This process is repeated for all five components to find the total per-diem rate.
Impact of the Variable Adjustment
It is important to note that PDPM rates are not static throughout a patient's stay. The PT and OT components decrease by 2% every seven days after Day 20. Similarly, the NTA component is paid at 3x the base rate for the first three days to account for higher initial medication and diagnostic costs.