On August 4, 2021, the Centers for Medicare and Medicaid Services (CMS) published the final rule in the Federal Register for fiscal year (FY) 2022 Skilled Nursing Facility Prospective Payment System (SNF PPS). It is a shift from the Prospective Payment System (PPS). Okay, why? 4145 0 obj <> endobj We also use third-party cookies that help us analyze and understand how you use this website. Landon Hackett, CPA, MSA, Director 317-713-7929 | lhackett@blueandco.com, Stephanie Fitzgerald RN, RAC-CTA, CPC, Manager 502-992-2582 | sfitzgerald@blueandco.com, Kayla May, CPA, Manager 317-275-7414 | kshelton@blueandco.com, Recent changes by the U.S. Department of Labor to the Form 5500, Form 5500-SF, and related instructions will impact future audit requirements for employee benefit plans. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Contact; 855-609-9960 IVR Guide C. Toileting Hygiene: The ability to maintain perineal hygiene, adjust clothes before and after using the toilet, commode, bedpan, or urinal. Please contact us for more information if you are interested. So how to plug in this code to get into the code. Based on feedback from our initial launch of this tool last year, QRM in collaboration with Data IQ are pleased to share this updated version. If a Correction Notice is issued that affects any Ohio counties, we will update our website links with the new rates. The proposed rule would increase SNF payments by 1.3% in FY 2022, with varying updates for hospital-based providers. 2023 CliftonLarsonAllen. If you are unable to see the form below, please complete your submission here. So when you just fill out the MDS, MDS gives you your PDPM code, Okay. Is a toileting program currently being used to manage the resident's bowel continence? Okay, sounds good. It is a shift from the Prospective Payment System (PPS). CLA (CliftonLarsonAllen LLP) is not an agent of any other member of CLA Global Limited, cannot obligate any other member firm, and is liable only for its own acts or omissions and not those of any other member firm. The codes come from the MDS. Similarly, CLA Global Limited cannot act as an agent of any member firm and cannot obligate any member firm. Okay. For the first 3 days of a residents stay, there are more costs associated with that resident. Oh, actually, the grand The, the total column A B, gotcha. This is the 14th year Blue & Co. has made the list and the fourth year to be designated as a Hall of Fame company for displaying sustained excellence during the programs history.Read the full announcement here: hubs.la/Q01DZ8N_0 See MoreSee Less. Effective October 1, 2018, SNFs who fail to submit required quality data to CMS under the SNF QRP will have their Medicare payment rates reduced by two percentage points. Okay. For most people working in long term care, this item may seem redundant, but its an important note for anyone who is trying to understand how PDPM payments work. Investment advisory services are offered through CliftonLarsonAllen Wealth Advisors, LLC, an SEC-registered investment advisor. When a resident hasnt been in a SNF or a hospital for at least 60 days in a row or has remained in a SNF but has not received skilled care there for at least 60 days in a row then they can be eligible for another 100 days of care. These are: The RUG scores were broken down into the following groups: RUG scores were determined by 20 MDS item fields which were grouped into: This method focused heavily on therapy as the driver for payment and as noted above, created negative incentives to drive up the amount of therapy services rendered. These blue columns are the end, the end product, the end rate for each of the components. This PDPM model, which took effect in late 2019, was developed for Medicare patients. Just put them in order and you have your code! They share the CMI the case mix index is how much the base rates, the Federal base rates for each component, what their multiplier is for this particular resonance. 4152 0 obj <>/Filter/FlateDecode/ID[<443F39AA5964884981B2B2C07BBE3971><86A7F7D8F227BB47A97600F5D4E2E4E7>]/Index[4145 17]/Info 4144 0 R/Length 57/Prev 281202/Root 4146 0 R/Size 4162/Type/XRef/W[1 2 1]>>stream Yeah, one of the one of the first drivers and coming up with the score is the primary diagnosis that the resident gets that gives them a clinical category, which kind of starts off the whole thing. And then start back at wherever you are right before that came in which I dont know where you were. Tell me how that goes? The Case Mix (CM) is the mix of the different kinds of therapy and services rendered for a resident. Is there a grand total? HIPPS. If you are unable to see the form below, please complete your submission here. Assurance, tax, and consulting offered through Moss Adams LLP. So if if they had an F, it would be the federal base rates times 1.61. Like I said, kind of for overhead meals, things like that, um, with the PDPM scores. Therapy used to be one of the big drivers for the RUGs scores. CMSs 2022 final skilled nursing facility (SNF) rule projects payments to SNFs will increase by $441 million in 2022 (FY22). Contact your local Blue & Co. Advisor or a member of our Post-Acute Care team, and we can assist you with understanding the new CMS changes, projections, and help your facility identify areas of missed opportunities. If you have questions regarding individual license information, please contact Elizabeth Spencer. More of the fun details of receivable frivolity of PDPM, 2023 Experience Care . The PPS used Resource Utilization Groups (RUG) rates to determine costs. (March 2, 2023) Blue & Co., LLC is honored to be named among Indianas Best Places to Work by the Indiana Chamber of Commerce. Gotcha. %%EOF Theres also the facility wage index that comes into play That is facilities specific, again, a little bit based on their location. These cookies track visitors across websites and collect information to provide customized ads. CMS SNF PPS Patient Driven Payment Model . These studies help healthcare organizations assess the potential risks and benefits of their proposed projects before investing significant time, money, and resources into planning for them.Read the article to see how a feasibility study can assist your organization.hubs.la/Q01F5Krs0 See MoreSee Less, Share on FacebookShare on TwitterShare on Linked InShare by Email, Blue & Co. is honored to be named among Indianas Best Places to Work by the Indiana Chamber of Commerce. It is a per diem payment model that calculates the payment to a facility based on clinical characteristics, patient assessments & diagnosis, and resource needs in the form of coordinated team-based care during a patients stay. Blue & Co.s FY 2023 PDPM SNF PPS Calculator can help you determine your Medicare daily reimbursement rates. It has been a month since regulation for the Centers for Medicare and Medicaid Services (CMS) Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) rates went into effect. Yeah, okay. Therefore, the FY 2021 ICD-10 diagnosis mappings will stay the same. They can accomplish this by pulling a paid claim and running it through the SNF pricer downloadable from the CMS website. ( 2023) a comparison of the facility average PDPM case mix to the Resource Utilization Group (RUG-IV) 48 group facility average case mix will be performed and individual rates may be adjusted as a result. This was incredibly helpful. Clinical assessment data is the basic input, and for payment purposes, at least one HIPPS code is defined to represent each case-mix group. Marcum has created an internal PDPM Medicare rate calculator. PDPM ICD-10 Mapping Theres information out on CMS. Understanding the Plan Audit Requirements Historically, an employee benefit plan has been required to receive an annual audit by an Independent Qualified Public Accountant (IQPA) when filing its Form [], CARMEL, Ind. Ventilator or Respirator While a Resident. The Minnesota certificate number is 00963. CLA (CliftonLarsonAllen LLP), an independent legal entity, is a network member of CLA Global, an international organization of independent accounting and advisory firms. The 100 day benefit period for the resident is up. And can they use this system to determine which primary diagnosis codes are going to give them the highest payouts? CMS released the skilled nursing facility (SNF) proposed rule for fiscal year (FY) 2022 on April 8, 2021. Each facility gets that same amount added to each daily per diem score for the resident base. This includes things like electricity, water, laundry services, and meals for your residents. Its a standard, I believe for 2020 it might be like 71.8 and then the difference 28 point something, okay. Its kind of a combination of a lot of of the questions. CLA Global Limited does not practice accountancy or provide any services to clients. That I can think of have their there is plenty of information out there to help determine how you can get the best score possible. To access rates for your SNF, click the link at the bottom of the page. So thank you so much. Okay. This PDPM model, which took effect in late 2019, was developed for Medicare patients. The same with PT in the OT. Or they may not need a qualified hospital state to come into the facility but with Medicare. Because of the fact that it is more expensive for the first three days they have to get everything put together, theres more expense. But as noted above, this caused some negative incentives for groups to pump up the number of hours their patients spent with therapists. lock Each year, CMS publishes updates to the regulations for inflation factors, wage index adjustments, and other patient-care related . Similarly, CLA Global Limited cannot act as an agent of any member firm and cannot obligate any member firm. FY 2023 PDPM SNF PPS Calculator is Now Available, PDPM Case Mix Rate Changes Due to Parity Adjustment FY 2023 Versus FY 2022, Download the FY 2023 PDPM SNF PPS Calculator Today. PDPM At-a-Glance Tool September 20, 2022 The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Modelphysical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. The current state fiscal year spreadsheet is updated monthly, around the 1st of each month, until FFS rate setting is complete for that rate year. Download the PDPM rate listing and calculator Access the county-based PDPM calculator by filling out the short form below. Why is that? Come down here to day 21 and we have it doing the 2% reduction. hb```cf`aH`P`p`pp 1u|ks&so[% Due to annual updates in CBSA wage indices, your countys change in Medicare rates may be higher or lower than the published 2.7% increase. Advertisement Overall Medicare Payment Increase: more than $900 million Calculate Part A Daily Rate Days 1-100 FY2022 Urban Rates / Not adjusted for Wage Index / Location Check 1 Item From Each Of The 5 Components Below To See Total Daily Rates for Days 1-100 If you have any specific questions about the Final Rule or how it might impact your facility, please contact Ashley Tkowski or Kevin Ware. Theres one more component that comes into play. And then tell me about like if I if Im if Ive got the PDPM Score here that PDPM code, and I take a look and I look at the patient and Im like, oh man, like this patient is not bringing in enough money to cover this patient. Let's get the conversation started and begin creating a customized solution for you. If you are unable to see the form below, please, Download the 2023 Skilled Nursing Facility PDPM PPS Rate Calculator, CMS New Reporting Requirements for Nursing Homes 2023, What Congress Is Facing in 2023 and How It Affects Health Policy, Inflation Reduction Act Unlocks New Cash Benefits for Tax-Exempts, If You Dont Monitor Your Internal Controls, Fraud May Find Its Way In, Provider Relief Fund & ARP Rural: What You Need to Know for 2023, CLAs Jon Hansen Quoted in McKnights Long-Term Care News, Why Nursing Home Primary Care and Risk-Based Strategies Must Go Hand in Hand, PHCA Nursing Economic Crisis Before Staffing Mandates. A handy calculator to guide you step-by-step through gathering the data necessary to determine a HIPPS code and estimated payment based on the Home Health PDGM (Patient-Driven Grouping Model). I think some of them in some of them is not really paying close enough attention to the primary diagnosis code. The final rule included some very good news for SNF providers! So there are Other things available that would kind of more help them determine which is the higher paying score, or diagnosis code. You also have the option to opt-out of these cookies. Okay. The calculator can assist you in seeing changes in reimbursement over the course of a Part A stay due to the potential impacts of tapering and AIDS diagnoses. Need additional guidance on the proper coding for PDPM? After the form is submitted, you will receive an email with a link to download. PDPM Calculator Tools -FY2022 Calculate SNF Medicare Part A Daily Rates for PPS Days 1-100 Base Rates are for FY2022 - October 1, 2021 to September 30, 2022 * These rates are NOT adjusted for YOUR SNF location. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. The names CLA Global and/or CliftonLarsonAllen, and the associated logo, are used under license. Will. Once the providers incorporate the revised rates, they can use best practices to validate that the rates calculate appropriately. Okay, sounds good. Three inter-related studies will be carried out. The MDS comes up and it gives you this score. If you have any questions, please complete our MDS helpline form. February 17, 2023 . Click the link below to download the calculator worksheet. Provider Nursing Home Rates *** No rows found *** . The names CLA Global and/or CliftonLarsonAllen, and the associated logo, are used under license. So the A, the first character is what score they got under the PT, the physical therapy, and also the occupational therapy. Thoughts of the Week. In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. With Interest Rates Soaring, Borrowers Turn to Buydown Agreements, 2023 Minnesota Government Training Academy, Addressing CPA Pipeline Requires Collaboration and Bold Leadership. So this is based on the facility, the facility needs to know whether theyre urban or rural. This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic. CMS has posted an updated PDPM ICD-10 mapping file on its website to assist providers with coding crosswalks and classification logic. The final rule also made adjustments to the technical mapping of certain conditions between ICD-10 diagnoses and PDPM groupings. Due to COVID-19, CMS will wait and monitor available data for developing the FY 2023 reimbursement data. Theres actually quite a number of those. Click on the tabs in the Excel sheet to calculate rates for the following (must have Microsoft Excel to open rate calculator spreadsheet): 2023 Medicare Supplement Rate Calculator 2022 Medicare Supplement Rate Calculator 2023 Individual Rate Calculator And then for the total, they just all get added up. All right, well, PDPM came about on October 1 2019, to replace the RUGs scores for long term care. The Minnesota certificate number is 00963. So you just put up So the MDS creates the PT and the nursing and all the different those different. Intermediate Care Facilities, by Jason Long | Sep 22, 2020 | Blog | 0 comments. Pre-Admission Id. A Knowledgeable and Compassionate partner. HIPPS codes are reported on claims to insurers. So its taking the base rate times the case mix index and giving you the score for that back for that day. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. endstream endobj startxref 2023 CliftonLarsonAllen. so PT and OT make up the very first code. label-my-dashboard ; label-my-profile . . This tool provides key Um, theres also a labor portion and a non labor portion. The FY 2022 release of the SNF PDPM Calculator is in a new format, and will require significant work to integrate. In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. This This was really enlightening. They go all the way through Z. The updated reduction will be set at 0.8% of providers rates. Provider Name : Provider ID. Thats it! Sign up to get the latest information about your choice of CMS topics. The third character is the nursing. FY 2022 Updated PDPM Rate Calculator As we launch into our first month-end close of FY 2022, click here to find the updated QRM/Data IQ PDPM Rate Calculator tool. If I just change the code, does it give me Does it change different things in there? Supervision or Touching Assistance 3. There are guidelines out on CMS website could tell you which, which you really are. AboutPressCopyrightContact. Theres no limit to the number of benefit periods a resident can have. They are clinically necessary, but not services rendered or overhead required to run. To get this resident settled into the room for the first three days and maybe figure out what meds they do need just a little more intense once theyre settled in it after about the fourth day, things calm down a bit, and theyre not spending quite as much time with the resident. These are: Federal Base Rates B. SNF Market Basket Update C. Case-Mix Adjustment D. Wage Index Adjustment E. SNF Value-Based Purchasing Program F. Adjusted Rate Computation Example Payment Model (PDPM), proposes to rebase and revise the SNF market basket, proposes to implement a recently-enacted SNF consolidated . Providers with more than 25 stays will receive back 60% of the 2% withheld regardless of previous performance measures. We used to say they would RUG out at a thing, but they would PDPM out in the assessment at the exact same code itself. So there are five, five components to the PDPM score. Due to a significant decrease in its wage index of (-4.9%), the rates for the Dayton-Kettering, OH CBSA (including Greene, Montgomery and Miami Counties) will decrease by approximately (-1.1%). This assessment would change the score effectively on the date that they complete the assessment. Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. Okay, sounds good. Medicare covers up to 100 days of care in a skilled nursing facility (SNF) for any benefit period. So it doesnt affect the dollars that youre receiving. With a comprehensive look by county, you can determine your facilitys rates by case-mix index and component groups, including PT, OT, SLP, NTA, nursing, and non-case mix. The links in the list below provide detailed calculations of the PDPM rates for each of the 15 CBSAs in Ohio. We anticipate some technical correction updates from CMS, and possible minor calculation or rounding errors for some situations, but overall Published on Feb 15 2016, Last Updated on Feb 25 2022 . The North Carolina certificate number is 26858. With a comprehensive look by county, you can determine your facilitys rates by case-mix index and component groups, including PT, OT, SLP, NTA, nursing, and non-case mix. The final rule updates the FY22 payment rates for the SNF Prospective Payment System (PPS), which will impact all facilities nationwide. They also need to be very aware of how They are answering making sure that theyre capturing all of the pieces that that resident requires in the MDS to make sure theyre getting the highest score possible. Under PDPM there are 161 Minimum Data Set (MDS) item fields. All rights reserved. BerryDunn created an interactive rate calculator to assist you with the calculation of your PDPM rates for FY 2021. Services from India provided by Moss Adams (India) LLP. Entry / Reentry Records We are available to assist you with any questions or issues you may have. Or is that the grand total on the far right on column AC? Okay. If you are not sure which CBSA to choose, please click the first link to open a crosswalk between the county names and the CBSA names. The top five rule increases and decreases for urban and rural CBSAs follow. POP ID POP ID: Invalid Characters: Rate Effective on Date* Rate Effective on Date*: Invalid date. Blue & Co. PDPM HIPPS Rate Calculator If you have questions or concerns, please contact us. And actually, Jason, I probably have something that we can add. Low utilization providers (i.e., those with fewer than 25 stays) will not be affected by VBP and will not receive a reduction in their rates. Use this calculator to guide you step-by-step through gathering the data necessary to determine aHIPPScode and estimated payment based on the Skilled Nursing FacilityPDPM(Patient-Driven Payment Model). Service Level Agreement | Terms & Conditions | Privacy Policy | ADA Compliance Statement, Triple check is an internal audit billing process used by long-term care facilities, The decision to admit a loved one into a nursing home is never easy, as nursing home, Understanding 835 files is essential for long-term care providers, as errors or, Senior living technology is constantly adapting in accordance with the needs of, Transitional care refers to the process of moving a patient from one healthcare, Streamline all of your financial processes, Maximize reimbursements & optimize your cash flow, A Team-Friendly Hospital & Physician Referral Portal, Fast & secure access to critical information, Implementation, Compliance, and Interoperability Assistance. Get timely coding industry updates, webinar notices, product discounts and special offers. Your SNF will either be an urban or rural facility and this will adjust your base rate. If you are unable to see the form below, please complete your submission here . So you have a through P. z means that theyre at a default, meaning you actually didnt do an assessment for them. Transparency in coverage machine-readable files. Your SNF will either be an urban or rural facility and this will adjust your base rate. Weve been more looking at the overall condition of the resident not being driven by how much therapy theyre receiving. To illustrate the impact of PDPM let's review a hypothetical . CLA (CliftonLarsonAllen LLP) is not an agent of any other member of CLA Global Limited, cannot obligate any other member firm, and is liable only for its own acts or omissions and not those of any other member firm. Topic Billing Policy . Last year, CMS proposed, but ultimately relented on, a 5% parity adjustment to bring PDPM payment down to a budget-neutral level. PDPM went into effect Oct. 1, 2019. PDPM was created to address, Speech Language Pathology (SLP): 33 MDS items, Non-Therapy Ancillary (NTA): 33 MDS items, RUG-IV: Resource Utilization Groups version 4, Activities of Daily Living (ADLs): 8 MDS items, Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets. Proportion of total calories the resident received through parenteral or tube feeding, B. Okay, um, yeah, so the PT and the OT scores. After the 60 days is up. Um, so its a little overwhelming, probably with all the columns on it. Give me whatever you got. On April 8, 2021, the Center for Medicare & Medicaid Services ("CMS") announced a proposed rate increase of 1.3 percent for skilled nursing providers in fiscal year 2022. (RUG) Rates and Patient Driven Payment Model (PDPM) Rates. Another valuable resource is a PDPM calculator that projects your HIPPS scores before the formal MDS, ensuring you never leave money on the table. Gotcha. Section GG - Functional Abilities and Goals, Section K - Swallowing/Nutritional Status, Section O - Special Treatments, Procedures, and Programs, NPI Look-Up Tool (National Provider Identifier). Gotcha. Gotcha. Fiscal year 2022 represents the third year of the Patient Driven Payment Model (PDPM) payment system for skilled nursing facilities. PDPM Cheat Sheet: How to Master the Patient Driven Payment Model. The proposed updates to the SNF payment rates include an increase of approximately $444 million in Medicare Part A . gear | Logout. No. AHA Take: 2023 PDPM Calculator Learn More PDPM Calculator Download the app from the App Store OPEN This video takes you through the step by step process of calculating PDPM rates.PDPM or the Patient Driven Payment Model is the current method for reimbursin. So when you get that when you get that code can tell me how it applies to how much money like you know, I see your your day ones your, you know, where do I. find my spreadsheet here? Im sure that lots and lots of people will find this really, really enlightening. The California license number is 7083. You can access the PPS rate calculator now. But in late July. Management Companies The for this variable per diem, additionally, the physical therapy and the occupational therapy starting on day 21 of the residents stay, those rates start to decrease by 2% every seven days, so on day 21, they dropped by 2% on day 28, another 2% they continue to drop every seven days like that until the hundred days is up. Wealth management offered through Moss Adams Wealth Advisors LLC. Setup or Clean-Up Assistance 4. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. So on day 21, they dropped by 2% on day 28, another 2%, and they continue to drop every seven days like that until the hundred days is up. Yeah, great. 2. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Administrative Level of Care Presumption under the PDPM (PDF), PDPM Payments for SNF Patients with HIV/AIDS (PDF), PDPM Functional and Cognitive Scoring (ZIP). These cookies do not store any personal information. Here is how the HIPPS PDPM codes come together: If the resident has a significant change in condition, then the facilities can do an interim payment assessment or IPA. Okay, so down here on my little spreadsheet. In fact, with PDPM, you can do an assessment, an admission assessment, and that score could remain the same for the resident. Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar, Enter the total number of venous and arterial ulcers present, 2. This is the 14th year Blue & Co. has made the list and the fourth year to be designated as a Hall of Fame company for displaying sustained [], Conducting a feasibility study is an essential step in determining the viability of implementing a new healthcare program, service, or project. Discover how to save hours each week. The California license number is 7083. HIPPS codes are reported on claims to insurers. Fiscal year 2023 represents the fourth year of the Patient-Driven Payment Model (PDPM) payment system for skilled nursing facilities. I see how its all put together. Is there a certain number of times that you can do those assessments? Through the finalized FY 2022 SNF PPS rule, CMS continues to refine the ICD-10 (International Classification of Diseases) diagnosis mappings in the PDPM. The first study will describe trends in supply of PDPM using law enforcement drug seizures data and national prescription . Well put it into the blog article. PDPM was created to address issues with the PPS RUG rates payment system that based payments on the volume of service and thus created negative incentives for facilities to boost the amount of services. any major mistakes that people make? The first reporting period will cover October 1, 2022, through March 31, 2023, and will be due by May 15, 2023. The rates will be effective from October 1, 2021 through September 30, 2022. You can find your categorization here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS, This item is different for most SNFs and you can find yours here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex. For that day. The 100 day benefit period for the resident is up. So if if somebody wanted to use your spreadsheet to do this, to calculate other kinds of variations on the code, I take it that spreadsheets can be available in the blog article that weve got attached to this video. Any other any other like big things that people miss or people forget or any really important things to bring up out of this. The cumulative rate calculator takes into account the variable per diem adjustment for the Physical and Occupational Therapy (PT/OT) and the Non-therapy Ancillary (NTA) payment. FY 2023 PDPM SNF PPS Calculator is Now Available November 16, 2022 It has been a month since regulation for the Centers for Medicare and Medicaid Services (CMS) Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) rates went into effect. It is a shift from the Prospective Payment System (PPS).
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