Overview
Rider 25 in the 2024-25 General Appropriations Act (GAA), House Bill 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission, Rider 25) provides appropriations for The Texas Health and Human Services Commission (HHSC) to “develop and implement a Texas version of the Patient Driven Payment Model (PDPM) methodology for the reimbursement of long-term stay nursing facility services in the Medicaid program to achieve improved care for long-term stay nursing facility services, excluding services provided by a pediatric care facility or any state-owned facilities.”
Methodology / Rules
The Reimbursement Setting Methodology for Nursing Facilities on or after September 1, 2025, is located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, Sup Chapter C. HHSC published 1 TAC Section 355.318 as adopted in the September 6, 2024 issue of the Texas Register.
Proposed Preamble and Proposed Rule Text (.pdf)
Approved NF Payment Rates, Effective September 1, 2025.
The Texas Health and Human Services Commission (HHSC) approved payment rates for Nursing Facilities (NF) effective September 1, 2025. HHSC will transition NF providers from the Resource Utilization Group, Version III (RUG-III) payment methodology to the Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) payment methodology, effective September 1, 2025. The approved PDPM LTC payment rates, effective September 1, 2025, can be accessed on the HHSC Provider Finance Department Website.
Public Rate Hearing on October 1, 2024
HHSC Provider Finance Department (PFD) held a Public Rate Hearing for proposed rates for the nursing facility services on October 1, 2024, at 9:00 a.m. Central Daylight Time (CDT). The rate hearing packets were posted on the PFD website on September 13, 2024, with a proposed effective date of September 1, 2025. The notice for the rate hearing was published in the September 6, 2024, issue of the Texas Register, and posted to the HHSC website on August 27, 2024.
Webinar: Overview of the Proposed Nursing Facility Patient Driven Payment Long-Term Care (PDPM LTC) Rate Methodology.
View the April 12, 2024 Webinar Recording (.wmv)