PDPM includes specific provisions to ensure that it accounts for the increased costs associated with caring for SNF patients with HIV/AIDS.

Is your facility prepared to manage complex care plans associated with higher acuity admissions?

Historically in accordance with §511(a) of the Medicare Modernization Act of 2003 (MMA Public Law 108-173) the previous Resource Utilization Groups, version IV (RUG-IV) model included a temporary 128% add-on for those SNF residents with AIDS, as identified through the presence of ICD.10.CM code B20 on the Medicare claim. However, the 128% add-on was a general approximation of the added cost of caring for AIDS based on data available on practices at that point in time. Subsequently, CMS found that for those SNF residents with AIDS, NTA costs per day were 151 percent higher, and wage- weighted nursing staff time was 18 percent greater, than for other residents.

As a result, PDPM aims to target reimbursement to the NTA and Nursing components of the rate. Under the NTA component, AIDS is assigned the highest point value (8 points) of any condition or service for purposes of classification. In addition, SNFs will receive an 18% add-on to the nursing component of the payment. The presence of AIDS will continue to be identified through the SNF’s entry of ICD.10.CM code B20 on the claim.

Access the PDPM AIDS Fact Sheet here.

PDPM includes incentives for SNFs to care for greater clinical complexity. Is your facility prepared to manage complex care plans associated with higher acuity admissions? Proactive recommends a comprehensive NTA clinical capabilities assessment and staff competency evaluation to prepare for PDPM success. Contact us for clinical program consulting solutions and check out our competency toolkits in the Proactive Shop, which include a nursing competency toolkit and identifying changes in condition toolkit.

Featured Toolkit: Basic Nursing Skills Competency Tool-Kit

This Tool-kit download includes an Editable Excel Workbook including an Orientation & Training checklist and 34 individual competency forms for evaluating a range of basic nursing skills. Toolkit details here.

Featured Toolkit: Identifying Changes in Condition Competency Tool-Kit

This Tool-kit download includes PowerPoint Slides, a Lesson Plan/Instructor Guide, and 3 Case Studies with Instructor Guidance, Case Study worksheets, a Return to Hospital Review tool, and a “Take Away” handout for participants. Toolkit details here.

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Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review

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