CMS Pub. 100-04, ch. 6, § 120.3

The Social Security Act requires that Medicare Part A-covered SNF stays be paid on a

per-diem basis. PDPM SNF PPS per diem payments will be reduced according to a

prescribed schedule, referred to as the VPD adjustment. Specifically, the PDPM provides

for an adjustment factor that is applied to certain components and changes the per diem

rate over the course of the stay.

Thus, under PDPM, the per diem rate for a given day of the SNF PPS stay may be

different from the prior day, depending on an adjustment factor that may be applied

against the SNF PPS rate connected with the HIPPS code. Moreover, the VPD schedule

applies only to the PT, OT, and NTA components of the per diem rate, with different

schedules for the PT/OT components than for the NTA component. A similar adjustment

exists under the Inpatient Psychiatric Facility (IPF) PPS.

For the PT, OT, and NTA components, the case-mix adjusted per diem rate is multiplied

against the variable per diem adjustment factor, following a schedule of adjustments for

each day of the patient’s stay

VPD Adjustment Schedules

PT & OT Components

Day in Stay Adjustment Factor Day in Stay Adjustment Factor

1-20 1.00 63-69 0.86

21-27 0.98 70-76 0.84

28-34 0.96 77-83 0.82

35-41 0.94 84-90 0.80

42-48 0.92 91-97 0.78

49-55 0.90 98-100 0.76

56-62 0.88

NTA Component

Day in Stay Adjustment Factor

1-3 3.00