The Great Transition: PDPM and the Medicaid Experience: DS25 Session

The modern Skilled Nursing Facility bears little resemblance to a "nursing homes" of the past. Sadly, payment systems have not kept pace. We've seen three iterations of Medicare's Prospective Payment System since 1999, with all providers bound to the same national model. Medicaid is state specific. Without the vast resources of CMS and the federal government, many state rate setting departments lack the resources to effectuate a comprehensive payment system update they've put it off so long that rates are effectively arbitrary in some markets. Now they have no choice, if case-mix adjustment is part of the rate setting equation, PDPM is the catalyst, and if your state isn't equipped to manage the change, you'll be dealing with a new private contractor's unfamiliar ideas and standards. PDPM is a revenue delivery system, it has nothing to do with funding. All things being equal, PDPM amounts to a redistribution of scarce Medicaid dollars among providers. SNFs that boasted high CMIs distorted by Rehab RUGs often find they haven't accurately captured the clinical issues that now drive payment. This presents a major problem with only one solution: The key to a successful transition is preparation. This session is presented by experts who have guided Skilled Nursing Facilities through dozens of payment system transitions. Speakers will share insights and review operational strategies that ensure your facility enjoys a "soft landing' and avoids "rate shock" that destabilizes the healthcare continuum. You'll gain access to PDPM capture patterns and benchmarks from providers in states that have already made the transition. These lessons will prove invaluable as you benchmark performance against competitors. Additionally, we'll explore innovative technologies designed to enhance compliant clinical-reimbursement management, ensuring your facility is prepared, even if your state is not.

• Explain payment system transition methodology and the importance of preparing for Medicaid payment changes.
• Apply strategies for compliant reimbursement capture within the new Medicaid payment system.
• Measure Medicaid case-mix index (CMI) performance relative to peer group benchmarks.
• Explain compliance implications associated with SNF technology.

Cost: $59 for AHCA/NCAL Members I $69 for Non-members

1 NAB credit available upon completion.  

Instructions to Register:

• For optimal performance, please use the latest version of Chrome, Firefox, Edge, or Safari 14+. 
• Members will need to log in using their existing email and password first. 
• Once you are logged in to the website, you will be able to register by clicking the green register button at the top right of the page. 
• If you have forgotten your password, click here. 
• If you are new to the site, you can create an account here. Answer all fields on the 'Create an Account' page, especially when locating your company name. You can search by name or zip code. After creating an account, you will be able to register. 
• If you are unsure if you are a member of AHCA, you can email update@ahca.org to confirm your membership status. 

Instructions to Begin, after registering: 

• To begin the training, click on the Contents tab.
• Participants can move throughout the lessons in the course by clicking on the header of each module to expand or minimize their view. 

Completion Deadline 

Individuals have until Oct. 31, 2026 to complete. After October 31st, 2026, this session will no longer be available to access or earn additional CEs.

Email educate@ahca.org if you need technical assistance.

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