On November 8, 2019, CMS published the final rule to implement the Medicare home health “Patient-Driven Groupings Model” (PDGM), a new payment model, starting on or after January 1, 2020. PDGM is an alternate case-mix adjustment methodology intended to place beneficiaries into more meaningful payment categories with a 30-day unit of payment, rather than the current 60-day episodes with service thresholds. The PDGM relies on timing, admission source, principal and other diagnoses, and functional impairment to place beneficiaries into one of 432 unique case mix groups; it eliminates the use of therapy service thresholds.
The primary . . .