PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables

PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables

? Please refer to the tables below when determining the Total PDPM Federal Urban and Rural Per-Diem Payment Rate(s) at Different Points of Stay located on the last page of the "AHCA PDPM Resident Classification Worksheets".

? To account for changes in resource PT, OT, and NTA utilization over the course of a SNF stay, PDPM utilizes a variable per-diem adjustment factor that adjusts the per-diem payment for these components over the course of the resident stay.

? NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. ? Beginning day 4 through the remainder of the stay the NTA component receives 100% of the base per-diem rate.

? PT and OT Components receive 100% of base per-diem rate for days 1-20 of a stay. ? After day 20, the base rate for PT and OT are reduced by 2% every seven days

? The PDPM payment model does not adjust the per-diem payment rates for the SLP or Nursing components. ? The FY 2019 RUG-IV rate table at the end will allow you to compare relative differences between the resident's PDPM

per-diem rates identified in the "AHCA PDPM Resident Classification Worksheet" with the Federal RUG-IV rate. ? NOTE: These tables do not contain geographic adjustments, so you should use this RUG-IV rate reference table and not your facility RUG-IV rate for this comparison.

PDPM NTA Variable Per-Diem Payment Rate Table

NTA Case-Mix

Group

NA NB NC ND NE NF

FY 2019

Federal Per-Diem Rate Urban

Day

Day

1-3

4-100

$760.99

$253.66

$592.40

$197.47

$433.18

$144.39

$313.76

$104.59

$224.78

$74.93

$168.59

$56.20

FY 2019

Federal Per-Diem Rate Rural

Day

Day

1-3

4-100

$726.96

$242.32

$565.91

$188.64

$413.81

$137.94

$299.73

$99.91

$214.73

$71.58

$161.05

$53.68

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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PDPM PT Variable Per-Diem Payment Rate Table ? Urban

PT

Case-

Mix

Day

Group 1-20

FY 2019 Federal Per-Diem Rate - Urban

Day 21-27

Day 28-34

Day 35-41

Day 42-48

Day 49-55

Day 56-62

Day Day Day Day Day Day 63-69 70-76 77-83 84-90 91-97 98-100

TA

$90.77 $88.96 $87.14 $85.33 $83.51 $81.70 $79.88 $78.07 $76.25 $74.44 $72.62 $70.80 $68.99

TB $100.27 $98.26 $96.26 $94.25 $92.25 $90.24 $88.24 $86.23 $84.22 $82.22 $80.21 $78.21 $76.20

TC $111.54 $109.31 $107.08 $104.85 $102.62 $100.39 $98.16 $95.92 $93.69 $91.46 $89.23 $87.00 $84.77

TD $113.91 $111.64 $109.36 $107.08 $104.80 $102.52 $100.24 $97.97 $95.69 $93.41 $91.13 $88.85 $86.57

TE

$84.25 $82.56 $80.88 $79.19 $77.51 $75.82 $74.14 $72.45 $70.77 $69.08 $67.40 $65.71 $64.03

TF

$95.52 $93.61 $91.70 $89.79 $87.88 $85.97 $84.06 $82.15 $80.24 $78.33 $76.42 $74.51 $72.60

TG $99.08 $97.10 $95.12 $93.14 $91.15 $89.17 $87.19 $85.21 $83.23 $81.25 $79.26 $77.28 $75.30

TH $68.82 $67.45 $66.07 $64.69 $63.32 $61.94 $60.56 $59.19 $57.81 $56.43 $55.06 $53.68 $52.31

TI

$67.04 $65.70 $64.36 $63.02 $61.68 $60.34 $59.00 $57.66 $56.32 $54.98 $53.63 $52.29 $50.95

TJ

$84.25 $82.56 $80.88 $79.19 $77.51 $75.82 $74.14 $72.45 $70.77 $69.08 $67.40 $65.71 $64.03

TK $90.18 $88.38 $86.57 $84.77 $82.97 $81.16 $79.36 $77.56 $75.75 $73.95 $72.15 $70.34 $68.54

TL

$64.67 $63.38 $62.08 $60.79 $59.50 $58.20 $56.91 $55.62 $54.32 $53.03 $51.74 $50.44 $49.15

TM $75.35 $73.84 $72.34 $70.83 $69.32 $67.81 $66.31 $64.80 $63.29 $61.79 $60.28 $58.77 $57.27

TN $87.81 $86.05 $84.30 $82.54 $80.78 $79.03 $77.27 $75.52 $73.76 $72.00 $70.25 $68.49 $66.73

TO $91.96 $90.12 $88.28 $86.44 $84.60 $82.77 $80.93 $79.09 $77.25 $75.41 $73.57 $71.73 $69.89

TP

$64.08 $62.79 $61.51 $60.23 $58.95 $57.67 $56.39 $55.11 $53.82 $52.54 $51.26 $49.98 $48.70

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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PDPM PT Variable Per-Diem Payment Rate Table ? Rural

PT

CaseMix Day Group 1-20

FY 2019 Federal Per-Diem Rate - Rural

Day 21-27

Day 28-34

Day 35-41

Day 42-48

Day 49-55

Day 56-62

Day 63-69

Day 70-76

Day 77-83

Day 84-90

Day Day 91-97 98-100

TA $103.47 $101.40 $99.33 $97.27 $95.20 $93.13 $91.06 $88.99 $86.92 $84.85 $82.78 $80.71 $78.64

TB $114.29 $112.01 $109.72 $107.44 $105.15 $102.87 $100.58 $98.29 $96.01 $93.72 $91.44 $89.15 $86.86

TC $127.14 $124.60 $122.06 $119.52 $116.97 $114.43 $111.89 $109.34 $106.80 $104.26 $101.72 $99.17 $96.63

TD $129.85 $127.25 $124.66 $122.06 $119.46 $116.86 $114.27 $111.67 $109.07 $106.48 $103.88 $101.28 $98.69

TE $96.03 $94.11 $92.19 $90.27 $88.35 $86.43 $84.51 $82.59 $80.67 $78.75 $76.83 $74.91 $72.99

TF $108.88 $106.71 $104.53 $102.35 $100.17 $98.00 $95.82 $93.64 $91.46 $89.29 $87.11 $84.93 $82.75

TG $112.94 $110.68 $108.42 $106.17 $103.91 $101.65 $99.39 $97.13 $94.87 $92.61 $90.35 $88.09 $85.84

TH $78.45 $76.88 $75.31 $73.74 $72.17 $70.61 $69.04 $67.47 $65.90 $64.33 $62.76 $61.19 $59.62

TI

$76.42 $74.89 $73.37 $71.84 $70.31 $68.78 $67.25 $65.72 $64.19 $62.67 $61.14 $59.61 $58.08

TJ $96.03 $94.11 $92.19 $90.27 $88.35 $86.43 $84.51 $82.59 $80.67 $78.75 $76.83 $74.91 $72.99

TK $102.80 $100.74 $98.69 $96.63 $94.57 $92.52 $90.46 $88.41 $86.35 $84.29 $82.24 $80.18 $78.13

TL $73.72 $72.24 $70.77 $69.29 $67.82 $66.35 $64.87 $63.40 $61.92 $60.45 $58.97 $57.50 $56.02

TM $85.89 $84.17 $82.45 $80.74 $79.02 $77.30 $75.58 $73.87 $72.15 $70.43 $68.71 $66.99 $65.28

TN $100.09 $98.09 $96.09 $94.09 $92.09 $90.08 $88.08 $86.08 $84.08 $82.08 $80.07 $78.07 $76.07

TO $104.83 $102.73 $100.63 $98.54 $96.44 $94.34 $92.25 $90.15 $88.05 $85.96 $83.86 $81.76 $79.67

TP $73.04 $71.58 $70.12 $68.66 $67.20 $65.74 $64.28 $62.81 $61.35 $59.89 $58.43 $56.97 $55.51

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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OT CaseMix Group

TA TB TC TD TE TF TG TH TI TJ TK TL TM TN TO TP

PDPM OT Variable Per-Diem Payment Rate Table ? Urban

FY 2019 Federal Per-Diem Rate - Urban

Day

Day

Day

Day

Day

Day

Day

Day

Day

Day

Day

Day

Day

1-20 21-27 28-34 35-41 42-48 49-55 56-62 63-69 70-76 77-83 84-90 91-97 98-100

$82.29 $90.02 $92.79 $84.50 $77.87 $87.82 $90.58 $63.51 $64.62 $79.53 $85.05 $61.31 $71.80 $82.29 $85.61 $60.20

$80.65 $88.22 $90.93 $82.81 $76.32 $86.06 $88.77 $62.24 $63.33 $77.94 $83.35 $60.08 $70.36 $80.65 $83.89 $59.00

$79.00 $86.42 $89.07 $81.12 $74.76 $84.30 $86.95 $60.97 $62.03 $76.35 $81.65 $58.85 $68.93 $79.00 $82.18 $57.79

$77.36 $84.62 $87.22 $79.43 $73.20 $82.55 $85.14 $59.70 $60.74 $74.76 $79.95 $57.63 $67.49 $77.36 $80.47 $56.59

$75.71 $82.82 $85.36 $77.74 $71.64 $80.79 $83.33 $58.43 $59.45 $73.17 $78.25 $56.40 $66.06 $75.71 $78.76 $55.38

$74.06 $81.02 $83.51 $76.05 $70.09 $79.03 $81.52 $57.16 $58.16 $71.58 $76.55 $55.17 $64.62 $74.06 $77.05 $54.18

$72.42 $79.22 $81.65 $74.36 $68.53 $77.28 $79.71 $55.89 $56.86 $69.99 $74.85 $53.95 $63.18 $72.42 $75.33 $52.98

$70.77 $77.42 $79.80 $72.67 $66.97 $75.52 $77.90 $54.62 $55.57 $68.40 $73.15 $52.72 $61.75 $70.77 $73.62 $51.77

$69.13 $75.62 $77.94 $70.98 $65.41 $73.77 $76.08 $53.35 $54.28 $66.81 $71.45 $51.50 $60.31 $69.13 $71.91 $50.57

$67.48 $73.82 $76.08 $69.29 $63.86 $72.01 $74.27 $52.08 $52.99 $65.22 $69.74 $50.27 $58.88 $67.48 $70.20 $49.36

$65.83 $72.02 $74.23 $67.60 $62.30 $70.25 $72.46 $50.81 $51.70 $63.62 $68.04 $49.04 $57.44 $65.83 $68.49 $48.16

$64.19 $70.22 $72.37 $65.91 $60.74 $68.50 $70.65 $49.54 $50.40 $62.03 $66.34 $47.82 $56.00 $64.19 $66.77 $46.96

$62.54 $68.42 $70.52 $64.22 $59.18 $66.74 $68.84 $48.27 $49.11 $60.44 $64.64 $46.59 $54.57 $62.54 $65.06 $45.75

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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PDPM OT Variable Per-Diem Payment Rate Table - Rural

OT

Case-

Mix

Day

Group 1-20

FY 2019 Federal Per-Diem Rate - Rural

Day 21-27

Day 28-34

Day 35-41

Day 42-48

Day 49-55

Day 56-62

Day 63-69

Day 70-76

Day 77-83

Day 84-90

Day

Day

91-97 98-100

TA

$92.54 $90.69 $88.84 $86.99 $85.14 $83.29 $81.44 $79.59 $77.74 $75.89 $74.04 $72.18 $70.33

TB $101.24 $99.21 $97.19 $95.16 $93.14 $91.12 $89.09 $87.07 $85.04 $83.02 $80.99 $78.97 $76.94

TC $104.34 $102.26 $100.17 $98.08 $96.00 $93.91 $91.82 $89.74 $87.65 $85.56 $83.48 $81.39 $79.30

TD

$95.03 $93.13 $91.23 $89.33 $87.43 $85.53 $83.62 $81.72 $79.82 $77.92 $76.02 $74.12 $72.22

TE

$87.58 $85.82 $84.07 $82.32 $80.57 $78.82 $77.07 $75.31 $73.56 $71.81 $70.06 $68.31 $66.56

TF

$98.75 $96.78 $94.80 $92.83 $90.85 $88.88 $86.90 $84.93 $82.95 $80.98 $79.00 $77.03 $75.05

TG $101.86 $99.82 $97.79 $95.75 $93.71 $91.67 $89.64 $87.60 $85.56 $83.53 $81.49 $79.45 $77.41

TH

$71.43 $70.00 $68.57 $67.14 $65.71 $64.28 $62.86 $61.43 $60.00 $58.57 $57.14 $55.71 $54.28

TI

$72.67 $71.22 $69.76 $68.31 $66.86 $65.40 $63.95 $62.50 $61.04 $59.59 $58.13 $56.68 $55.23

TJ

$89.44 $87.65 $85.86 $84.07 $82.28 $80.49 $78.71 $76.92 $75.13 $73.34 $71.55 $69.76 $67.97

TK

$95.65 $93.74 $91.82 $89.91 $88.00 $86.08 $84.17 $82.26 $80.35 $78.43 $76.52 $74.61 $72.69

TL

$68.94 $67.56 $66.18 $64.81 $63.43 $62.05 $60.67 $59.29 $57.91 $56.53 $55.15 $53.77 $52.40

TM

$80.74 $79.13 $77.51 $75.90 $74.28 $72.67 $71.05 $69.44 $67.82 $66.21 $64.59 $62.98 $61.36

TN

$92.54 $90.69 $88.84 $86.99 $85.14 $83.29 $81.44 $79.59 $77.74 $75.89 $74.04 $72.18 $70.33

TO

$96.27 $94.35 $92.42 $90.49 $88.57 $86.64 $84.72 $82.79 $80.87 $78.94 $77.02 $75.09 $73.17

TP

$67.70 $66.35 $64.99 $63.64 $62.28 $60.93 $59.58 $58.22 $56.87 $55.51 $54.16 $52.81 $51.45

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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PDPM SLP Per-Diem Payment Rate Table

SLP Case-Mix Group

SA SB SC SD SE SF SG SH SI SJ SK SL

FY 2019 Federal Per-Diem Rate

Day 1-100 - Urban $15.06 $40.31 $58.92 $32.34 $51.61 $65.79 $45.19 $63.13 $77.75 $66.01 $81.73 $92.81

FY 2019 Federal Per-Diem Rate

Day 1-100 - Rural $18.97 $50.78 $74.21 $40.73 $65.01 $82.86 $56.92 $79.52 $97.93 $83.14 $102.95 $116.90

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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PDPM Nursing Per-Diem Payment Rate Table

Nursing Case- FY 2019 Federal Per-Diem Rate FY 2019 Federal Per-Diem Rate

Mix Group

Day 1-100 - Urban

Day 1-100 - Rural

ES3

$417.98

$399.27

ES2

$316.59

$302.42

ES1

$301.07

$287.60

HDE2

$247.27

$236.20

HDE1

$205.89

$196.67

HBC2

$230.72

$220.39

HBC1

$191.40

$182.84

LDE2

$214.16

$204.58

LDE1

$177.95

$169.99

LBC2

$176.92

$169.00

LBC1

$147.95

$141.33

CDE2

$192.44

$183.82

CDE1

$167.61

$160.10

CBC2

$159.33

$152.20

CBC1

$138.64

$132.43

CA2

$111.74

$106.74

CA1

$97.25

$92.90

BAB2

$107.60

$102.78

BAB1

$102.43

$97.84

PDE2

$162.43

$155.16

PDE1

$152.09

$145.28

PBC2

$125.19

$119.58

PBC1

$116.91

$111.68

PA2

$72.42

$69.18

PA1

$68.28

$65.23

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

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RUX RUL RVX RVL RHX RHL RMX RML RLX RUC RUB RUA RVC RVB RVA RHC RHB RHA RMC RMB RMA RLB RLA

RUG-IV FY 2019 Federal Per-Diem Rate Table ? Urban & Rural

Urban $832.61 $814.47 $741.10 $664.89 $671.44 $598.87 $615.93 $565.12 $540.92 $631.22 $631.22 $527.80 $541.51 $468.94 $467.12 $471.86 $424.68 $373.88 $414.53 $389.13 $320.18 $403.03 $259.69

Rural $851.84 $834.50 $748.46 $675.65 $670.29 $600.95 $609.14 $560.60 $530.19 $659.43 $659.43 $560.63 $557.78 $488.45 $486.71 $479.61 $434.54 $386.01 $416.73 $392.46 $326.60 $398.45 $261.51

Urban Rural

ES3

$760.16 $734.10

ES2

$595.04 $576.36

ES1

$531.54 $515.69

HE2

$513.40 $498.35

HE1

$426.31 $415.15

HD2

$480.74 $467.15

HD1

$400.90 $390.88

HC2

$453.52 $441.15

HC1

$379.13 $370.08

HB2

$448.08 $435.95

HB1

$375.50 $366.62

LE2

$466.22 $453.29

LE1

$390.02 $380.48

LD2

$448.08 $435.95

LD1

$375.50 $366.62

LC2

$393.65 $383.95

LC1

$331.96 $325.01

LB2

$317.44 $364.88

LB1

$415.42 $311.15

CE2 CE1 CD2 CD1 CC2 CC1 CB2 CB1 CA2 CA1 BB2 BB1 BA2 BA1 PE2 PE1 PD2 PD1 PC2 PC1 PB2 PB1 PA2 PA1/Default

Urban $448.08 $375.50 $393.65 $360.99 $344.66 $319.26 $319.26 $295.67 $270.27 $252.12 $286.60 $273.90 $237.61 $226.72 $382.76 $364.62 $360.99 $342.84 $310.18 $295.67 $263.01 $252.12 $217.65 $208.58

Rural $404.75 $373.55 $383.95 $352.75 $337.15 $312.88 $312.88 $290.35 $266.08 $248.75 $281.68 $269.55 $234.88 $224.48 $373.55 $356.22 $352.75 $335.42 $304.21 $290.35 $259.15 $248.75 $215.81 $207.14

Copyright 2019 American Health Care Association. All Rights Reserved.

PDPM Component Per Diem and RUG-IV Rate Reference Table 4/15/19 Update

8

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