HIPPS Updates and Structure Changes

120.1 - HIPPS Updates and Structure Changes (Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19) Under PDPM, the HIPPS code is structured differently, as a result of there being five case-mix adjusted rate components under the revised model. The first position represents the Physical and Occupational Therapy case-mix group. The second position represents the Speech-Language Pathology case-mix group. The third character represents the nursing case-mix group. The fourth character represents the Non-Therapy Ancillary (NTA) case-mix group. The fifth character represents the AI code. CMS would note that this also affects the number of potentially valid HIPPS codes under PDPM, as compared to RUG-IV. The PPS assessment schedule under PDPM is also significantly different from that used under RUG-IV. The only assessments under PDPM that would produce a HIPPS code would be the initial Medicare (“5-day”) PPS assessment, which follows the same schedule as under the previous RUG-IV model, and the optional Interim Payment Assessment (IPA), which may be completed at any point during a PPS stay. The initial SNF PDPM HIPPS Codes can be found online at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes.html Note: AAA00 default will be replaced with ZZZZZ effective October 1, 2019.