State to Activate PDPM Codes for Nursing Home Medicaid Assessments
In a Dear Administrator Letter (DAL) to nursing homes dated Jan. 12th, the Department of Health (DOH) notified providers that the State will be making a change to their internal Minimum Data Set (MDS) systems. This change will end Resource Utilization Group III (RUG-III) codes and activate codes based on the Patient-Driven Payment Model (PDPM) for Medicaid MDS assessments. This change will be made on Jan. 22nd and will be retroactive for assessments filed since Oct. 1, 2023.
While this will be an administrative, non-substantive change, enabling these codes retroactive to Oct. 1st may result in warning messages for some older assessments. The Department is NOT requiring facilities to go back and submit modifications on already submitted assessments. While PDPM will be turned on retroactive to Oct. 1, 2023, for practical purposes DOH will consider January through March 2024 to be the first quarter of complete and reliable PDPM data.
Members will recall that with the Centers for Medicare and Medicaid Services (CMS) limiting support for RUGs, the State has announced the intent to shift to a case mix methodology based on PDPM, which is the basis for Medicare Part A payments. Once the January 2024 Medicaid rates are issued, there will be no further case mix updates until DOH implements the new methodology, which is yet to be developed. While it is unclear whether any Medicaid assessments filed during the freeze will be eventually used to adjust rates, or how exactly PDPM will be adapted to adjust Medicaid rates, LeadingAge NY recommends that providers submit complete assessments based on Medicare PDPM conventions and taking all of the components into consideration. The DAL is available here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841