PDPM Payment Changes: What Skilled Nursing Facilities Should Be Watching
The Patient Driven Payment Model (PDPM) continues to evolve, and while major revisions have not yet been finalized, industry experts expect additional updates may be on the horizon. Federal regulators have been reviewing potential changes to non-therapy ancillary (NTA) payments, comorbidity classifications, and reimbursement structures. For skilled nursing facilities, understanding these possible shifts now can help reduce financial risk and support stronger compliance in the future.
According to McKnight's Long-Term Care News, CMS has been evaluating proposed changes to PDPM’s NTA component for several years. Although updates were initially introduced in a proposed rule for 2025, they were ultimately not finalized, meaning providers are still operating under the original PDPM structure implemented in 2019. However, experts expect the topic could resurface in upcoming rulemaking cycles.
Potential Changes to NTA Points
One of the biggest areas under review involves adjustments to NTA points, which provide additional reimbursement for residents with complex medical needs. Earlier proposals suggested reducing points for certain high-cost treatments while adding new qualifying conditions.
For example, CMS previously proposed:
Reducing NTA points for some treatments such as ventilator care
Adjusting reimbursement tied to certain diagnoses
Removing or modifying select conditions currently on the NTA list
These changes could significantly impact reimbursement levels depending on a facility’s patient population and coding practices.
Possible New Comorbidities and Diagnoses
Another area being discussed is the addition of new comorbidities that better reflect the needs of today’s skilled nursing population. Behavioral health conditions—including anxiety, bipolar disorder, and post-traumatic stress disorder—have been mentioned as possible additions in earlier proposals.
Industry experts note that adding these diagnoses could better align reimbursement with the complexity of residents being treated in skilled nursing settings. If adopted, these updates may also encourage providers to strengthen behavioral health programs and documentation practices.
Why Facilities Should Prepare Now
Even though the final structure of these changes remains uncertain, preparation is essential. Payment adjustments can have a direct impact on revenue, operational planning, and care documentation processes.
Facilities that begin preparing now can:
Review current coding and documentation practices
Evaluate how NTA changes might affect reimbursement
Strengthen MDS accuracy and staff education
Monitor rulemaking updates from CMS
Taking proactive steps now can help organizations adapt more smoothly if changes are implemented.
Turning Policy Changes into Opportunity
PDPM was designed to evolve as CMS gathers more data about patient needs and care costs. As a result, future updates are likely to continue refining how skilled nursing services are reimbursed. Facilities that stay informed and align clinical documentation with regulatory expectations will be better positioned to succeed under any new payment structure.
Health Advisory Partners by Aegis Therapies is here to help you prepare. From staff training and MDS coaching to operational best practices, our team works with facilities to stay ahead of regulatory changes and strengthen performance.
Contact Health Advisory Partners today to schedule a consultation and start preparing for upcoming PDPM changes.
Health Advisory Partners welcomes all persons in need of its services and does not discriminate on the basis of age, disability, race, color, national origin, ancestry, religion, gender identity, sexual orientation or source of payment. Interpreter Services are available at no cost. Please visit Health Advisory Partners for assistance. Servicios de interpretación están disponibles sin costo. Visite su sucursal local de Aegis Therapies para recibir asistencia. 我们提供免费传译服务。请探访您的本地Aegis Therapies地点以获得协助