NY Medicaid Will Shift To PDPM Reimbursement System

New York providers prepare for BIG changes – Medicaid payments will shift to a PDPM reimbursement system over the next few months!

Removal of Section G from the MDS assessment effective 10/1/23 forced state Medicaid directors to consider moving to a Patient Driven Payment Model (PDPM) reimbursement system for Medicaid payments.

New York State Department of Health (NYS DOH) confirms, NYS will not transition to the Optional State Assessment (OSA) to collect data and obtain a RUG calculation for Medicaid reimbursement. Instead, NYS DOH is developing a plan to transition to PDPM for Medicaid reimbursement. The final RUGs-related rate will be on January 1, 2024.

Still in the early planning stages of the transition, NYS DOH is considering a rate freeze after January 1, 2024. They will be working with stakeholders to develop a future methodology that captures acuity changes and is tailored to the LTC population in NYS.

Contact Celtic today, let’s discuss how we can help you navigate this transition.

With our proven track record in PDPM, we’ve helped our clients to optimize revenue and sustain gains.

As faculty of the American Health Care Association (AHCA), Celtic provided original PDPM training for New York providers. Recognized for our expertise in PDPM, we are advisors to multiple state associations for the Medicaid payment system transition to PDPM. With exclusive insight, we position our clients to be successful.

About Lauren Videtto