Pennsylvania is transitioning to the Patient Driven Payment Model (PDPM) for the setting of the Medical Assistance (MA) payment rates for nursing homes. This regulation was approved on June 26, 2025 and was published in the Pennsylvania Bulletin on August 2, 2025.
This change results in nursing facilities no longer being required to complete the OSA (Optional State Assessment). The PDPM replaces the RUG III that has previously been used. The transition is in process and Pennsylvania will utilize the nursing component only of the PDPM. Nursing documentation and Activities of Daily Living (ADLs) are important support components for the MDS coding for the PDPM for Medicaid Case Mix Index (CMI). Additional information can be found in the RAI Spotlight from August 2025.
