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Effective July 1, 2025, Medicaid physician reimbursement rates increased to 85% of the March 2024 Region 99 Medicare rates for applicable services. Reimbursements at or above this threshold will remain the same.
Continues the July 1, 2025 Emergency Rule which adopted cell and gene therapy model that provides additional supplemental and federal rebates for gene therapies for sickle cell disease.
Continues the June 30, 2025 Emergency Rule which amended the provisions governing reimbursement for Nursing Facilities to revise the language and to replace resource utilization group resident classification system with the patient driven payment model.
Adopts a new methodology for Medicaid managed care organization reimbursement and fee-for-service reimbursement rates to better align Medicaid rates to Medicare rates.
Amends the provisions governing refugee medical assistance (RMA) to shorten the period that assistance is granted through the refugee medical assistance (RMA) program from one year to four months.
Amends the provisions governing inpatient hospital services, to allow reimbursement for gene therapies for sickle cell disease outside the per diem rate and paid based on the actual acquisition cost in order to take advantage of a federal rebate.
Amends the provisions governing reimbursement for Nursing Facilities to revise the language and to replace resource utilization group resident classification system with the patient driven payment model (PDPM). The PDPM shifts the focus from therapy-based payments to a more patient-centered approach that takes into account the individual needs and conditions of residents. This action is being taken to comply with federal requirements.