Late last week, The Division of Medicaid Services (DMS) released a memo outlining the updated processes for contesting adjustments, requesting an administrative review, or resubmitting a cost report. Please see the details below for more information.

The Methods of Implementation for Nursing Home Payment Rates for state fiscal year 2024 (SFY24) on the ForwardHealth website include an updated process and timeline for contesting adjustments, requesting an administrative review, or resubmitting a cost report. This information was shared during the July 24, 2023, public meeting. A summary of the requirements follows. Providers should review the Methods of Implementation for additional detail.

DHS auditors finalize rates as follows:

1. 16 days after and including the date of the initial notification of draft rates, if the provider did not inform their auditor of the provider’s intent to contest adjustments.
2. 31 days after and including the date of the initial notification of draft rates, if the provider did inform their auditor of the provider’s intent to request changes but did not provide the request and substantiating documentation by the 30th day.
3. Immediately upon notification by the provider that the provider accepts the rate. If a provider accepts the rate, the provider waives the ability to contest an auditor adjustment. If a provider accepts the rate, the provider waives the ability to request an administrative review.
4. Immediately upon notifying the provider of the results of the Department of Health Services (DHS) auditor’s review of the contested adjustments, if applicable.
5. Immediately upon notifying the provider of the determination from additional administrative review the provider requested for contested adjustments, if applicable.

Contesting auditor adjustments

To contest rates a facility must notify DHS in WINHRS of their intent to contest no later than 15 days after and including the date of the initial rate notification. To contest rates in WINHRS, facilities should click the link in the email they receive from WINHRS notifying them of their rates, and then click the lightning bolt icon under the Action column.

Facilities have 31 days after and including the date of the initial rate notification to provide additional documentation via WINHRS, to indicate which audit adjustment each document is responding to, and to explain why the provider disagrees with the auditor’s determination.

Providers may only contest the disallowance of costs by the DHS auditor. A provider is not allowed to contest an adjustment if they do not both notify DHS within 15 days of the initial rate notification and provide applicable documentation and information within 31 days of the initial rate notification.

Requesting administrative review

To request an administrative review, a facility must have already contested auditor adjustments and received a response from the assigned auditor. Facilities may request an administrative review via email to dhsdmsbrs@dhs.wisconsin.gov. No additional documentation may be provided during an administrative review. The administrative review is a review of the existing records submitted by the facility to WINHRS.