Guidance on Nursing Facility State Plan Payment and Upper Payment Limit Approaches in Medicaid Relying on the Medicare Patient-Driven Payment Model (SMD 22-005)
This letter provides guidance to states as they consider transitioning from the Resource
Utilization Groups (RUGs) to the Patient-Driven Payment Model (PDPM) to pay Medicaid
nursing facilities, as well as incorporating PDPM payments as the basis for nursing facility upper
payment limit (UPL) demonstrations.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 21, 2022
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.