July 24, 2025

Patient Driven Payment Model (PDPM) Case Mix Transition Moving Forward

On July 24, 2025 by Jeff Bostic

One of the changes approved by the Legislature this year is a transition of the nursing home case mix system to using the PDPM nursing weights to adjust rates instead of RUGs-IV weights. This change will be effective Oct. 1, 2025.

New Rate Notices Forthcoming

DHS is currently working on the rate calculations and plans to post new rate notices with PDPM rates by August 15. They are also working on resources for billers to help them understand how to bill after the transition, and we will share those as soon as they are available.

In addition to the transition in October, which will be based on costs and resident days from the 2023 cost report, DHS will also be updating rates as scheduled for 2026. Those rates will be based on the costs and resident days from the 2024 cost reports. DHS plans to issue those rates by November 15 as required by law each year.

DHS recently reported to LeadingAge that almost 50 nursing homes have not filed their PDPM resident days by payer for 2024. Without that information, DHS will not be able to set the 2026 rates and deliver a rate notice by the statutory deadline. Providers who have not submitted that information should use this tool and return it to Deb Doughty at DHS.