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Final Rule Moves Forward with PDGM

Posted on Monday, November 4, 2019 1:23 PM

CMS released the PDGM final rule on October 31st as anticipated, alleviating any question that PDGM will move forward in CY2020. There are a few small changes between the proposed rule previously issued in July 2019 and the final rule in areas such as reimbursement rate increase as well as the actual start date of PDGM. The reimbursement rate was increased in the final rule compared to the draft rule previously published, moving to $420M instead of $400M as previously proposed. The start date of PDGM in the final rule indicated on or after January 1, 2020 rather than a firm start date of January 1, 2020, allowing for CMS to ensure that HHA vendors as well as their own systems are in fact ready for the changes that the PDGM brings; this is to ensure minimal claim processing impact as well as afford CMS the ability to push the start date of PDGM past January 1, 2020 should significant challenges be identified related to technology preparation.  

The final rule can be viewed in it’s entirety here.

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