PDPM Transition Announced for Pennsylvania!

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Big changes are coming with the transition to the Patient-Driven Payment Model (PDPM), as outlined in the Notice of Final-Form Rulemaking from the Department of Human Services Office of Long-Term Living approved on May 14, 2025. Here's what you need to know:

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1. Rates will be determined using a mix of the Nursing Clinical Category of PDPM and RUG-III during the transition.

2. RUG-III portion will be frozen based on an average of two quarters using the May 1st and August 1st, 2025, Picture Dates.

3. The transition will happen in four phases:

• Phase 1 (April 2026 rates) – 25% PDPM | 75% RUG-III (Picture Date: 11/01/2025)

• Phase 2 (July 2026 rates) – 50% PDPM | 50% RUG-III (Picture Date: 02/01/2026)

• Phase 3 (October 2026 rates) – 75% PDPM | 25% RUG-III (Picture Date: 05/01/2026)

• Phase 4 (January 2027 rates) – 100% PDPM (Picture Date: 08/01/2026)

 

What does this mean for your facility?

The May 1st and August 1st picture dates have become the most critical rate-setting dates since 2009! As August approaches, it is vital to ensure your community captures all services provided to residents in documentation and on the Minimum Data Set (MDS).

Stay proactive. Stay informed. Ensure accurate documentation!