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Medicaid Rates

PDPM Transition Status

State Medicaid Rates

Updated: 12.13.2023

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Updated: 08.02.2023

Alabama

Non-Case Mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Alaska

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Arizona

Level-based system
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Arkansas

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

California

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 09.12.2023

Colorado

RUG-III 34 snapshot
07.01.2023 Snapshot
07.01.2024
Colorado began PDPM data collection with the 07.01.2023 snapshot date. Every CMI correctible listing that will be posted and available after 04.01.2023 will only contain PDPM CMI scores.

Updated: 08.02.2023

Connecticut

State announced in April they are requiring the OSA to continue their RUG-IV model. An OSA will need to be performed on all federally required assessments that would be able to generate a RUG for current reimbursement to continue to collect all necessary data.
RUG-IV 48 time-weighted
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
We have not received any official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments.
With requiring the OSA the state will be able to continue ahead with their current RUG-IV reimbursement model roll out timeline.

Updated: 08.02.2023

Delaware

Delaware patient index
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Florida

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 09.02.2023

Georgia

Frozen RUG-III Rates until 03.31.2023 Snapshot
RUG-III 34 snapshot
03.31.2024 snapshot
07.01.2024
State has been providing shadow rates for PDPM rates since the 07.01.2023 rate release. The 9/30/23 snapshot CMI data will be frozen until the 03.31.2024 snapshot which will be used to determine reimbursement rates for 07.01.2024.

Updated: 09.02.2023

Hawaii

RUG-III 34 Snapshot
05.01.2023 Snapshot
01.01.2024 (using PDPM data from 05.01.2023 and 08.01.2023 snapshots)
The state will use PDPM data that was collected during the 05.01.2023 and the 08.01.2023 snapshot periods to establish rates for 01.01.2024. The rates will be adjusted every six months with new PDPM case mix information from alternating snapshot periods.

Updated: 08.02.2023

Idaho

RUG-III 34
To be determined
At an undetermined future date when the state has sufficient data and time to model rates using PDPM. State to continue modeling through state fiscal year 2023.
A provider letter was sent on 03.24.2023 indicating required OSA use starts on 10.01.2023 for all federally required assessments. Failure to complete an OSA with the same ARD as a federally required assessment will prevent the state from being able to calculate a RUG and will result in the record being assigned to the delinquent BC1 category.

Updated: 08.02.2023

Illinois

PDPM snapshot
RUG-IV 48 + PDPM snapshot
03.31.2022 snapshot
07.01.2022 (began phase-in of PDPM rates)
The transition to a Nursing CMG PDPM payment model will finish for the 10.01.2023 rate calculation with only using PDPM data from the 06.30.2023 snapshot.

Updated: 08.02.2023

Indiana

RUG-IV 48 time-weighted

No decision by the Office of Medicaid Policy and Planning had been made as of May 2023 per the Myers and Stauffer transition FAQ with new new infromation in Myers and Stauffer’s newsletters for Case Mix in Indiana.
No decision by the Office of Medicaid Policy and Planning had been made as of May 2023 per the Myers and Stauffer transition FAQ with new new information in Myers and Stauffer’s newsletters for Case Mix in Indiana.
OSA use starts on 10.01.2023 for all federally required assessments where a RUG would currently be established.

Updated: 08.02.2023

Iowa

PDPM time-weighted
RUG-III 34 time-weighted
07.01.2023
07.01.2024
Facilities began collecting only PDPM data for time weighted rosters on 07.01.2023 which included assessments completed prior to that quarter. In conjunction with the change to PDPM the state is moving to six month CMI capture period for biannual rate adjustments instead of quarterly.

Updated: 08.02.2023

Kansas

RUG III on 10.01.2023 snapshot but PDPM for Q4
RUG-III 34 snapshot
01.01.2024 snapshot (anticipated)
07.01.2024 (anticipated)
10.01.2023 will be the last snapshot where RUG data is used which will be used for setting the 01.01.2024 rates. If the state proceeds as planned without requiring an Optional State Assessment (OSA) beginning 10.01.2023, then they will not be able to determine a RUG classification for assessments completed on 10.01.2023 or after. So if any assessments completed on the 10.01.2023 picture date will not be included in the facility average unless another accommodation is made to be able to capture that RUG data. However as of 07.11.2023, the State has not made a final decision regarding transitioning from RUG to PDPM.

Updated: 07.25.2023

Kentucky

PDPM time-weighted
RUG-III 34 time-weighted
01.01.2024
07.01.2024
Q3 2023 patient RUG data collection will be used to establish rates for 01.01.2024 which will be frozen throughout the 04.01.2024 rate period until 07.01.2024 when Q1 2024 PDPM data capture will determine rates.

Updated: 08.14.2023

Louisiana

As of 07.28.2023 a decision has not been made
In conjunction with Admission, Quarterly, Annual, and Sig Change OBRA assessments
RUG-III 34 time-weighted
Potential change at a future date after additional modeling and data collection for rebasing has occurred
Potential change at a future date after additional modeling and data collection for rebasing has occurred

Updated: 09.11.2023

Maine

An OSA will need to be completed with the same ARD as all OBRA assessments used for payment purposes.
RUG-III 44
Uknown
Uknown
Maine is requiring the OSA be performed in conjunction with all assessments used for payment purposes starting on 10.01.2023 to continue the existing RUG III reimbursement model. The state has not yet finalized any plans for a changed payment mode.

Updated: 09.02.2023

Maryland

Frozen RUG-IV 48 Rates until 07.01.2024 Time-Weighted data collection
RUG-IV 48 time-weighted
07.01.2024
07.01.2025
State initial PDPM implementation plan was postponed and then changed to using a 07.01.2024 PDPM data capture to establish 01.01.2025 rates. For rates up until 12.31.2024 they will be freezing the last or last several quarters’ CMI scores.

Updated: 08.29.2023

Massachusetts

MMQ
07.01.2023
10.01.2023
The state defined active assessment on 10.01.2023 will determine the residents active payment level until the next active assessment is completed. MMQs will still need to be completed for any billable dates prior to 10.01.2023, but not for any after. There will be 25 PDPM Nursing CMG categories.

Updated: 08.02.2023

Michigan

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated 08.02.2023

Minnesota

RUG-IV 48
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
The state is also adding two additional items to Section S, the start and end dates of isolation.

Updated: 08.02.2023

Mississippi

RUG-IV 48 time-weighted
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
The state will be continuing their current RUG-IV time weighted reimbursement model through the use of the OSA.

Updated: 08.02.2023

Missouri

Undetermined
RUG-IV 48 snapshot
10.01.2023 (potential option)
07.01.2024 (potential option)
MDS RUG data through 09.30.2023 will be used for establishing Medicaid rates until 06.30.2024. The reimbursement model for 07.01.2024 will be determined after the annual rate review process that will occur in the Spring of 2024, a PDPM model will be considered as the a potential future reimbursement model at that time.

Updated: 08.02.2023

Montana

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Nebraska

PDPM
RUG-III 34
07.01.2023 active assessments
07.01.2023
Nebraska transitioned from RUG III 34 to PDPM for Medicaid daily rates on 07.01.2023 under existing reimbursement structure.

Update: 12.13.2023

Nevada

RUG-III 34 snapshot
As early as 10.01.2023
07.01.2024
State is in the final planning stages of a transition to a PDPM reimbursement model using Nursing CMGs, but there is discussion about including other PDPM CMGs into the final model.

Updated: 08.02.2023

New Hampshire

PDPM snapshot (unconfirmed)
RUG-IV snapshot
02.28.2024 snapshot (unconfirmed)
07.01.2024 (anticipated)
State will not have first PDPM snapshot until 2024 under current schedule.

Updated: 08.02.2023

New Jersey

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

New Mexico

High + Low NF Lvls
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

New York

Frozen RUG-III rates from 04.01.2023 to 09.30.2023 data collection period.
RUG-III 53 six month average
At future date
At future date
Freezing RUG CMI average from 04.01.2023 to 09.30.2023 for use with future rate periods. State is still in the initial planning stages of move to a PDPM reimbursement model.

Updated: 08.02.2023

North Carolina

An OSA will need to be completed with the same ARD as all federally required assessments starting 10.01.2023 until the planned change in reimbursement model no later than 10.01.2025.
RUG-III 34 time-weighted
No later than 10.01.2025
No later than 04.01.2026
OSA use starts on 10.01.2023 for all federally required assessments where a RUG would currently be established.

Updated: 08.02.2023

North Dakota

RUG-IV 48
Unconfirmed
Unconfirmed
State has used only OSAs to determine state Medicaid RUG categories for individual resident payment rates. This model will continue to be supported by CMS until 09.30.2025.

Updated: 08.02.2023

Ohio

RUG-IV 57 snapshot
12.31.2024 snapshot (anticipated potential)
07.01.2025 (anticipated potential)
Providers have the choice to freeze their 03.31.2023 CMI score for SFY 2024 and 2025 or continue with current RUGs reimbursement model using OSA. Providers must notify the state of their decision by 10.01.2023 deadline. The Ohio Department of Medicaid is working to create an online reporting tool that would allow providers to submit their choice. Once the choice has been made there is no statutory option for a reconsideration during the biennium. If the CMI score is chosen to be frozen any Medicaid resident that grouped into PA1-2 in the March 2023 quarterly report will remain at that level for the biennium. Ohio indicated in their April training that if they go to a PDPM reimbursement model that they would use the Nursing CMG to establish scores.

Updated: 08.02.2023

Oklahoma

Non-case-mix
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Oregon

Complex medical add-on
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Pennsylvania

An OSA will need to be completed with the same ARD as all federally required PPS and OBRA assessments starting 10.01.2023. An OSA will not be needed for discharge assessments.
RUG-III 44 snapshot
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.

Updated: 08.02.2023

Rhode Island

An OSA will need to be completed with the same ARD as all federally required assessments starting 10.01.2023 until the planned change in reimbursement model on 10.01.2025.
RUG-IV 48
10.01.2025 (anticipated)
10.01.2025 (anticipated)
OSA use for 10.01.2023 through 09.30.2025 for all federally required assessments with a planned change to a PDPM model on 10.01.2025.

Updated: 08.02.2023

South Carolina

Non-case-mix
We have not received any communication on transitioning to a PDPM model for Medicaid rate acuity adjustments.
We have not received any communication on transitioning to a PDPM model for Medicaid rate acuity adjustments.

Updated: 08.02.2023

South Dakota

PDPM (proposed)
RUG-III 34
07.01.2023 (proposed)
07.01.2023 (proposed)
The state has a pending proposal for 07.01.2023 rates PDPM effective date.

Updated: 08.02.2023

Tennessee

PDPM time-weighted
RUG-IV 48 time-weighted
10.01.2023
07.01.2024
The state is transitioning to PDPM data collection during the 10.01.2023-03.31.2023 period for the biannual rate set on 07.01.2024.

Updated: 08.02.2023

Texas

RUG-III 34
05.03.2024 (potential)
09.01.2024 (potential)
The state is requiring that an additional 55 fields be entered into the LTC portal for the LTCMI that were previously autofilled by the corresponding MDS submitted MDS assessment for that ARD to be able to continue to collect RUG data.

Updated: 08.02.2023

Utah

PDPM time-weighted
RUG-III 34 time-weighted
01.01.2023
07.01.2023
Moved to PDPM reimbursement rates on 07.01.2023 but the state will still require OSAs starting on 07.01.2023 to establish RUGs for UPL calculations.

Updated: 10.06.2023

Vermont

RUG-IV 48 Snapshot
03.15.2024 Snapshot
07.01.2024
Vermont announced September will be the last month they will collect RUG data as they will be transitioning to a new PDPM Nursing CMG Medicaid reimbursement model for next July’s rates. For April rate calculations, they will use either the Q3 CMI score or an average CMI of multiple quarters for the case mix component. The new PDPM Nursing CMG Medicaid reimbursement model will collect its first PDPM data for reimbursement in Q1 of 2024 for use with the March 15 census date snapshot in order to establish July 1 rates.

Updated: 08.18.2023

Virginia

RUG-IV 48
10.01.2025 (unconfirmed)
10.01.2025 (unconfirmed)
OSA use starts on 10.01.2023 for all federally required assessments where a RUG would currently be established.

Updated: 10.05.2023

Washington

RUG-IV 57 time-weighted
10.01.2023 (potential)
07.01.2024
The Department plans on implementing the new PDPM system in some capacity beginning with the July 1, 2024 rate. The details of the implementation won’t be finalized until after Legislative session.

Updated: 08.31.2023

West Virginia

For assessments with an ARD on or after 10.01.2023, and until a rebase of reimbursement rates occurs that incorporates a PDPM resident classification methodology, an OSA with the same ARD will need to be completed in conjunction with it.
RUG-III 29
Unconfirmed
Following a period where data can be collected for rebasing facility rates.

Updated: 08.02.2023

Wisconsin

PDPM
01.01.2022
01.01.2022
Wisconsin has been using PDPM model based on Nursing and NTA CMGs since 01.01.2022.

Updated: 08.02.2023

Wyoming

RUG-IV
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
Official communication on transitioning to a PDPM model for Medicaid rate acuity adjustments has not yet been received.
OSA use starts 10.01.2023 for all federally required assessments where a RUG would currently be established.