Medicaid Reimbursement
Wisconsin Medicaid is a joint federal and state program that provides high-quality health care coverage, long-term care, and other services to over one million Wisconsin residents. There are many types of Medicaid programs. Each program has different rules, such as about age and income, that you must meet to be eligible for the program.
Medicaid Nursing Home fee-for-service rate setting and reimbursement is governed by the authority of Wis. Stat. §. 49.45(6m). The Division of Medicaid Services uses a methodology known as the Methods of Implementation for Wisconsin Medicaid Nursing Home Payment Rates.
Please contact WHCA/WiCAL Vice President of Reimbursement Policy Kate Dickson for more information.
Nursing Home Reimbursement Rate Setting
Nursing Home Reimbursement Rate Setting
The Methods of Implementation for Wisconsin Medicaid Nursing Home Payment Rates (the Methods) is our rate-setting methodology, as issued by the Department of Health Services, in accordance with Wisconsin statutes and federal guidelines. The methods are used and updated annually by the Bureau of Rate Setting in the Division of Medicaid Services. The Methods defines cost reporting, allowable expenses, payment allowances and calculations, special rate adjustments, bed hold billing, and labor factors.
The Methods is used to set Medicaid daily payment rates for nursing facilities and a smaller number of intermediate care facilities for individuals with intellectual disabilities. It is also used as a reference for definitions and policy, for such topics as related party transactions, prudent buyer concept, self-funded Insurance, restricted use beds, and many others.
Case Mix Index Resident Rosters
Case Mix Index Resident Rosters
Quarterly case mix index (CMI) summary resident rosters for nursing home rates are available through the ForwardHealth Portal.
To access your case mix roster, log in to the ForwardHealth Portal and click on “Trade Files,” then “File Download.” The rosters are only accessible to the portal administrator and to those with the portal security role “trade files”.
To grant access to a staff member who already has a portal account but does not have the “trade files” security role, have your portal administrator follow the instructions for adding a role, which can be found in section 6.2 of the Provider Portal Account User Guide (P-00952).
To request provider portal access, complete the Request Portal Access on the ForwardHealth website.
Summary rosters are released quarterly and will remain available for download for a period of one year after their release.
To request a detailed resident roster showing the CMI of every assessment for each resident and the corresponding number of patient days at each Resource Utilization Groups (RUGs) level, please contact your regional auditor.
Licensed Bed Assessment
Licensed Bed Assessment
The Licensed Bed Assessment e-Payment (LBAP) is a web based application which allows the nursing homes to make electronic check payments. This payment method is in addition to the current paper check payment process. It allows you to combine payments due for multiple licenses and multiple months.
Make a Bed Assessment Payment Now!
Need help? Click HERE to view the LBAP user guide.
Wisconsin Nursing Home Rate Setting Platform (WINHRS)
Wisconsin Nursing Home Rate Setting Platform (WINHRS)
Medicaid Cost Reports are an essential component for calculating Medicaid Long-Term Care payments to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities.
The Wisconsin Nursing Home Rate Setting platform (WINHRS) is where providers can submit cost reports and communicate with their auditor.
If you have any questions, please contact WINHRSHelpDesk@mslc.com.
Archive
Archive
Medicaid Advocacy
- 2019-21 SNF Payment Reform Request
- SNF Medicaid Underspend Paper
- SNF Closures 2016-2019
Methods of Implementation
- SFY20 Methods of Implementation for Nursing Home Payment Rates
- SFY19 Methods of Implementation