The information below shows the thresholds for patients’ functional levels based on the 12 clinical groups within the Patient-Driven Groupings Model (PDGM).
 
Functional points under PDGM are based on responses to eight items within OASIS-D: M1800 (Grooming); M1810 (Current ability to dress upper body); M1820 (Current ability to dress lower body); M1830 (Bathing); M1840 (Toilet transferring); M1850 (Transferring); M1860 (Ambulation/locomotion); and M1033 (Risk of hospitalization).
 
The sum of those points leads to a functional score used group home health periods into a functional level: low, medium and high.
 
The following information is based on 2017 CMS data.
 
For PDGM’s implementation in 2020, CMS plans to update the functional points and thresholds based on analysis of 2018 home health claims, and using the most current version of the OASIS data set.
 
Clinical group
Level of impairment
Points (2017 data)
Behavioral health
Low
0-36
Medium
37-52
High
53+
Complex nursing interventions
Low
0-38
Medium
39-58
High
59+
Musculoskeletal rehabilitation
Low
0-38
Medium
39-52
High
53+
Neuro rehabilitation
Low
0-44
Medium
45-60
High
61+
Wound
Low
0-42
Medium
43-61
High
62+
MMTA — Surgical aftercare
Low
0-24
Medium
25-37
High
38+
MMTA — Cardiac and circulatory
Low
0-36
Medium
37-52
High
53+
MMTA — Endocrine
Low
0-51
Medium
52-67
High
68
MMTA — Gastrointestinal tract and genitourinary system
Low
0-27
Medium
28-44
High
45+
MMTA — Infectious disease, neoplasms and blood-forming diseases
Low
0-32
Medium
33-49
High
50+
MMTA — Respiratory
Low
0-29
Medium
30-43
High
44+
MMTA — Other
Low
0-32
Medium
33-48
High
49+
Source: CMS