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LTCOP Transitioning from RUG to PDPM LTC for Nursing Facilities

Date: 05/05/25

Effective September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) Long- Term Care Online Portal (LTCOP) will transition from the Resource Utilization Group (RUG) system to the Patient Driven Payment Model Long-Term Care (PDPM LTC) methodology for Nursing Facility daily care reimbursement.

This change modernizes Texas Medicaid’s payment system and aligns reimbursement more closely with residents’ care needs. Since 2020, the Texas Health and Human Services Commission (HHSC) Provider Finance Department (PFD) has worked with the Nursing Facility Payment Methodology Advisory Committee (NF-PMAC), which includes Nursing Facility owners, association leaders, and Managed Care Organization (MCO) representatives, to evaluate alternatives to the RUG system. The committee recommended PDPM LTC as the optimal replacement. In 2023, the 88th Texas Legislature reinforced this direction through Rider 25, which mandates the implementation of PDPM LTC.

Summary of Change

  • Transition Date: PDPM LTC will apply to all assessments with an Assessment Reference Date (ARD) of September 1, 2025, or later.
  • System Update: TMHP’s LTCOP will calculate and display PDPM LTC values based on data submitted from the Minimum Data Set.
  • New Billing Codes: HHSC will implement new codes for daily care services under PDPM LTC, including specific codes for residents with an HIV/AIDS diagnosis.

Action Required by Providers

  • Prepare for Transition: Ensure that your facility updates claim templates and billing systems to accommodate the new PDPM LTC codes.
  • Continue Current Practices: Use the RUG methodology for assessments conducted with ARDs prior to September 1, 2025. Once residents are reassessed on or after that date, you must use PDPM LTC.
  • Submit Assessments: Continue submitting MDS Omnibus Budget Reconciliation Act (OBRA) assessments and the LTC Medicaid Information (LTCMI) in accordance with federal and state guidelines.
  • Monitor Updates: Regularly check the TMHP and HHSC PFD websites for guidance and training resources.
  • Request Support: Contact the TMHP LTC Help Desk for technical assistance related to the transition.
  • Sunset RUG: HHSC will disable Section RUG in the LTCOP. The system will no longer calculate RUG levels after the transition.

For additional information, visit the TMHP LTC webpage or HHSC PFD’s Patient Driven Payment Model for Long-Term Care Rate Setting Methodology for Nursing Facilities webpage.

For technical assistance, contact the TMHP LTC Help Desk at 1-800-626-4117 and select option 1.