Fig. 2

Flow chart of the PT&OT, SLP, nursing and NTA in PDPM assignment logic. PDPM consists of the four case-mix adjusted payment components: physical therapy and occupational therapy (PT&OT), speech-language pathology (SLP), nursing (NUR), and non-therapy ancillary (NTA). For PT&OT, patients are categorized based on their clinical category (e.g., major joint replacement, other orthopedic, medical management, and non-orthopedic surgery and acute neurologic). Further grouping is determined by the patient’s PT&OT function score (0–24), reflecting their functional ability. Based on these criteria, patients are assigned to specific PDPM groups such as TAB, TE, or TH. In SLP, the patient’s neurologic condition, SLP-related comorbidities, or cognitive impairments are assessed. They are then evaluated for a mechanically altered diet or swallowing disorder. Patients are placed into SLP groups (S1-S7) based on these conditions. In Nursing (NUR), the first criterion is whether the patient requires extensive services (e.g., tracheostomy or ventilator). If not, the next step evaluates whether they need special care or are clinically complex (e.g., depression). If neither applies, the process moves to whether the patient has behavioral symptoms or reduced physical function. Each patient is assigned a nursing function score (0–16), and based on their needs, they are placed into one of several nursing groups such as HS2, CSE1, or RB. For NTA, patients are assigned an NTA score based on their medical complexity and need for non-therapy services. They are then grouped into one of the NTA categories (NA-NF), with higher scores indicating more complex needs