June 9, 2020

Retroactive to October 1, 2019, TRICARE has adopted the Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) payment methods, including Minimum Data Set (MDS) assessments, Patient-Driven Payment Model (PDPM) classifications and Medicare weights and per diem rates.

TRICARE’s PDPM model

Under PDPM, there are six payment components. Five are case-mix adjusted to allow for diagnostic variances and illness severity; the sixth is non-case-mix adjusted and covers SNF resources that do not vary according to beneficiary characteristics.

• Physical Therapy (PT) – includes a variable per diem factor
• Occupational Therapy (OT) – includes a variable per diem factor
• Speech Language Pathology (SLP)
• Nursing
• Non-Therapy Ancillary (NTA) services – includes a variable per diem factor

See the TRICARE Reimbursement Manual, Chapter 8, Section 2 for more information.