IN THE NEWS

When federal news concerning Medicare happens, stay in the know.

PDPM Transition Announced for Pennsylvania!

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:

Rates will be determined using a mix of the Nursing Clinical Category of PDPM and RUG-III during the transition.
RUG-III portion will be frozen based on an average of two quarters using the May 1st and August 1st, 2025, Picture Dates.
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!

PROPOSED RULEMAKING

The Pennsylvania Department of Health has published the proposed rulemaking for the transition from the RUG-III version 5.12. to the PDPM Nursing Clinical Category. You can view and download the proposal from here;

Pennsylvania Bulletin (pacodeandbulletin.gov)

The comment period is open for 30 days.

Optional State Assessment Available for States to use for Payment Purposes

CMS released the Optional State Assessment, OSA, for states to complete information that will allow them time to transition to the current PDPM model by October 2025. This OSA has Data Sets that are necessary for previous types of reimbursement models such as RUG-IV and RUG-III. The OSA information can be found on the CMS Minimum Data Set page at Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual | CMS

CMS Releases FY 2025 Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities

CMS released the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2024.

The proposed rule can be found here

CMS Releases DRAFT MDS 3.0 version 1.20.1

CMS released the DRAFT MDS 3.0 version 1.20.1 late last month in an effort to improve facility's ability to prepare for the changes. . As we review the information, we will create educations on the updates. Please stay tuned for updates and if you are interested in having educations done by Stever Advisors, please contact us.

The DRAFT can be found here