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Mississippi Medicaid (DOM)Medicaid · Reimbursement · Prior Authorization · MS · Physical Therapy, Occupational Therapy, Speech TherapyHigh impact

Nursing home payment methodology to transition from RUG-IV to Patient-Driven Payment Model (PDPM)

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 21, 2026

Summary

Mississippi Medicaid is transitioning nursing home payment methodology from RUG-IV to Patient-Driven Payment Model (PDPM) effective January 1, 2026. The new model uses a blended approach with five components: Nursing (50%), Physical Therapy (15%), Occupational Therapy (15%), Non-Therapy Ancillary (12%), and Speech Language Pathology (8%).

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What to do

by Jan 1, 2026 · 5 steps
01Billing teams at nursing facilities must transition from RUG-IV to PDPM methodology for all Mississippi Medicaid claims.
02Update billing systems to use new PDPM component weightings and CMI values provided in the policy.
03Implement new therapy per diem rates for physical therapy, occupational therapy, and speech language pathology.
04Complete new cost reporting forms with therapy schedule when available.
05Attend DOM training sessions in October 2025.
If missed: Failure to transition will result in incorrect reimbursement rates.

Original notice

Nursing home payment methodology to transition from RUG-IV to Patient-Driven Payment Model (PDPM)
medicaid.ms.gov · Always check the source before changing claims.
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Related policy hubs

Mississippi Medicaid (DOM) policiesMS policy changesPhysical TherapyOccupational TherapySpeech Therapy

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