09/18/2025
Ohio Department of Medicaid Releases Fact Sheet on PDPM Transition
The Ohio Department of Medicaid (ODM) has released a new fact sheet outlining the state’s transition to the Patient Driven Payment Model (PDPM) reimbursement methodology for nursing facilities. This change, authorized by House Bill 96, will impact how facilities are reimbursed for direct care services beginning in 2026.
PDPM is a case-mix classification system developed by the Centers for Medicare and Medicaid Services (CMS). It uses information from the Minimum Data Set (MDS) 3.0 to group residents according to their clinical characteristics and care needs. These groupings then determine reimbursement levels. The system is designed to better reflect resident acuity and align payment with the resources required to provide care.
Key Implementation Dates:
- January 1, 2026: ODM will begin using PDPM acuity groupings for the direct care portion of reimbursement. Rates will be adjusted by one-third of the difference between current Resource Utilization Group (RUG)-based rates and the new PDPM rate.
- July 1, 2026: Rates will be adjusted by two-thirds of the difference.
- January 1, 2027: Rates will again reflect two-thirds of the difference.
- July 1, 2027: PDPM will be fully implemented for direct care reimbursement.
During the transition, ODM will apply a case-mix multiplier to align the RUG and PDPM scores until the next statewide rebasing occurs. The nursing component will follow the federal fiscal year 2024 PDPM weights established by CMS.
Providers with questions are encouraged to reach out to ODM at NFRatesetting@medicaid.ohio.gov or NFPolicy@medicaid.ohio.gov.
