MedicaidReimbursementMedium impact
MSA 19-24
Michigan Medicaid - MDHHS·MI · Geriatrics, Palliative Care·Provider Bulletin
Effective date
Dec 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan Medicaid is transitioning State Veterans' Homes from Resource Utilization Group (RUG) payment system to Patient Driven Payment Model (PDPM) effective December 1, 2019. Billing teams must update HIPPS codes and billing procedures to reflect the new six-component PDPM rate structure instead of RUG classifications.
Action Required
By December 1, 2019: Billing teams for State Veterans' Homes and hospice providers must update billing systems to use PDPM methodology instead of RUG classifications. Update HIPPS codes to reflect the new five-digit format representing PT/OT score, SLP score, Nursing score, NTA score, and MDS assessment type (always ending in 6 for OBRA assessments). Modify billing procedures to report revenue codes, HIPPS codes, covered days, occurrence code 50, and MDS Assessment Reference Date in claim notes. For transition period, use RUG methodology if Assessment Reference Date is before October 1, 2019, and PDPM if on or after October 1, 2019.