Date: June 21, 2024

Budget Adjustment Factor and Patient Driven Payment Model (PDPM)

Public Comment Period for State Plan Amendment (SPA): Budget Adjustment Factor and Patient Driven Payment Model (PDPM)


Notice is hereby given that the New Hampshire (NH) Department of Health and Human Services (the Department) is proposing to amend the Title XIX State Plan to modify the nursing home reimbursement methodology by revising the Budget Adjustment Factor (BAF) and replacing The Resource Utilization Group-IV (RUG-IV, is no longer available on an updated basis through the Center for Medicare & Medicaid Services, CMS) model with the nursing component of the Patient Driven Payment Model (PDPM, available through CMS).
Effective July 1, 2024, the Department is replacing RUG-IV with PDPM and applying an updated budget adjustment factor (BAF) of 28.76% rather than 25%, to the nursing facility per diem rate in order to arrive at rates within budget for providing nursing facility services in the Title XIX Program. The fiscal impact as a result of the change in the nursing facility BAF is expected to result in an increase in expenditures of $8,886,637 for the remainder of federal fiscal year 2024, and $35,546,546 for federal fiscal year 2025.
Copies of draft State Plan pages will be available by August 1, 2024. Please contact Jody Farwell at (603) 271-9421, or via e-mail at, to request copies. The amendments to the State Plan pages may undergo further revisions before and after submittal to the Centers for Medicare and Medicaid Services (CMS) based upon public comment or CMS feedback. Comments will be due by August 15, 2024, and should be e-mailed to or mailed to the Department of Health and Human Services, Division of Medicaid Services, 129 Pleasant Street–Brown Building, Concord, NH 03301-3857, ATTN: Jody Farwell.