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Wisconsin Department of Health Services

Wisconsin Department of Health Services

Medicaid Cost Reports are considered to be public information. Cost Reports submitted in 2014 or later can be publicly accessed on this website by clicking on the section below. To obtain copies of Cost Reports for years prior to 2014, please follow the process described on the DMS website.

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Important Contact Information
Address:
Myers and Stauffer LC
150 Flynn Avenue, Suite 200
Frankfort, KY 40601

Phone: 502.695.6870
Toll Free Phone: 888.749.5799
Fax: 502.695.3068

Wisconsin Nursing Home Rate Setting (WINHRS) Questions:
Help Desk Phone: 800.763.2278
Help Desk Email: WINHRSHelpDesk@mslc.com

Publicly Available Cost Reports

Wisconsin Department of Health Services makes provider submitted cost reports publicly available.

Family Care MCO Rates by RUG/PDPM Category

The Family Care MCO rates by RUG category spreadsheets display nursing facility daily rates by RUG-IV (48 cell) category for use by Family Care MCOs. The spreadsheets provide rates by state fiscal year, going back seven years. Each file displays the final July 1 Medicaid fee-for-service (FFS) non-DD rate based on the average FFS Medicaid case mix index (CMI) for each facility. Please note that the FFS rates are updated quarterly based on changes in the average CMI values for each facility, these quarterly updates are not included in the Family Care MCO spreadsheet as they only apply to FFS residents. Effective January 1, 2022, the spreadsheets will provide rates for each PDPM Nursing and NTA category.

The current state fiscal year spreadsheet is updated monthly, around the 1st of each month, until FFS rate setting is complete for that rate year.  If you have questions regarding the spreadsheet or rates, please contact your nursing home’s assigned auditor or email Rene Eastman (Rene.Eastman@dhs.wisconsin.gov), the Nursing Home Policy and Rate Setting Section Manager.

Patient-Driven Payment Model (PDPM) Billing Guidance

Patient-driven payment model (PDPM) billing guidance in a topical format relating to minimum data set assessments is available. This document describes policies for applying assessments to dates of service and generating valid Health Insurance Prospective Payment System (HIPPS) codes.

HIPPS codes will be required for non-developmentally disabled inhouse nursing home per diem claims billed to Medicaid fee-for-service for dates of service on and after January 1, 2022.  This document has also been posted on DHS’ website at https://www.dhs.wisconsin.gov/nh-rates/resources.htm.

Cost Report Templates

A current version of the Wisconsin Medicaid Nursing Facility Cost Report Template and COVID Supplementary Schedules are now available.