State Provides PDPM Project Update
(Aug. 12, 2025) On Aug. 6th, LeadingAge NY and other associations met with the Department of Health (DOH) and the State’s contractor, Myers and Stauffer, to get a status update on NY’s efforts towards transitioning to a PDPM-based case mix adjustment for nursing home Medicaid rates. The takeaway was that acuity adjustments are not likely to resume for at least another year.
The State has made no updates to nursing home Medicaid rates to reflect resident acuity since July 2023, when the state froze case mix adjustments pending the development and implementation of a PDPM-based methodology. This means that the state continues to pay Medicaid rates using RUG-III based case mix adjustments that reflect Minimum Data Set (MDS) assessments covering October 2022 through March 2023.
To accomplish the transition, a process made necessary by the discontinuation of federal support for the legacy RUG methodology, New York contracted with Myers and Stauffer, a national consulting firm that has assisted a number of other states in this process. During a project update provided in May, DOH messaged the intent to implement the new methodology in a 2-step process. This would have established an interim case mix methodology using only the Nursing or the Nursing and Non-Therapy Ancillary components of PDPM, pending the implementation of a final methodology that may have included additional components informed by more complete data analysis that was scheduled to be complete in late 2026.
The most recent update rescinds this original timeline and suggests an intent to maintain the freeze until late 2026, perhaps longer, due to additional data analysis requirements. Myers and Stauffer staff indicated that MDS data veracity concerns make Myers reticent to make a methodology recommendation at this time. In turn, DOH staff expressed an unwillingness to proceed with an interim methodology that may be portrayed as based on inaccurate data. Given that the state envisions the need for both regulations and federal approval prior to the implementation of a new case mix methodology, the realistic date for the resumption of acuity adjustments to Medicaid rates becomes very uncertain but may well stretch into 2027. Because this timeline undermines the effectiveness of acuity adjustments and may negatively impact many members, LeadingAge NY is advocating for a more expedited approach. We invite member comments, questions and concerns.
Although the implementation date of Medicaid PDPM is uncertain, we urge members to ensure that Medicaid residents are assessed accurately and completely, to ascertain that staff is fully trained and understands PDPM dynamics, and to make sure that appropriate documentation verifying assessment coding is completed and retained. Accurate assessment data is critical to the analyses that will inform the development of the new methodology. In addition, with implementation dates uncertain, there is no way to predict the timeframe of the MDS assessments that may be used to adjust rates when acuity adjustments resume. These may include assessments being submitted currently.
As reported last week, LeadingAge national recently unveiled a Medicaid PDPM resource for members. The resource guide, described here, is designed to help nursing homes prepare for success under a Medicaid PDPM methodology and provides a scan of implementation activities in other states across the U.S.
Contact: Darius Kirstein, dkirstein@leradingageny.org, 518-867-8841