MedicaidReimbursementHigh impact
Nursing home payment methodology to transition from RUG-IV to Patient-Driven Payment Model (PDPM)
Mississippi Medicaid (DOM)·MS · Physical Therapy, Occupational Therapy, Speech Therapy·Prior Authorization
Effective date
Jan 1, 2026
We identified it
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%).
Action Required
By January 1, 2026: Billing teams at nursing facilities must transition from RUG-IV to PDPM methodology for all Mississippi Medicaid claims. Update billing systems to use new PDPM component weightings and CMI values provided in the policy. Implement new therapy per diem rates for physical therapy, occupational therapy, and speech language pathology. Complete new cost reporting forms with therapy schedule when available. Attend DOM training sessions in October 2025. Failure to transition will result in incorrect reimbursement rates.