This page includes resources for the Managed Care Organizations (MCOs) for operationalizing the nursing home benefit in Family Care.
Nursing Home Rates
Effective July 1, 2015
- Family Care MCO Rates by RUG Category
If a provider is not listed on the July 1, 2015 rate worksheet, please use the July 1, 2014 worksheet as interim rates. If you have any questions, please contact Rene Eastman (608-264-9870).
Prior Year's Rates:
- July 1, 2014 RUGs-48 rates (Excel, 482 KB) Updated 3/23/16
- 11-02 MCO Access and Contracts with Nursing Home Commissions formed under s. 49.49(7) (PDF, 43 KB revised 8/28/14; replaces memo TA 10-05)
- Changes to Coverage, Daily Rate, and Billing Instructions for Negative Pressure Wound Therapy Pumps for Nursing Homes
- Memo to MCOs: Changes in Coverage for Negative Pressure Wound Therapy Pumps in Medicaid Nursing Home Daily Rate (PDF, 41 KB)
- Memo to MA Nursing Home Providers: Managed Care Organization billing for Negative Pressure Wound Therapy Pumps (PDF, 36 KB)
- Forward Health Update 1010-104 (December 2010) (PDF, 105 KB)
- 10-10: Technical assistance documents providing guidance to Managed Care Organizations for implementing the Resource Utilization Grouper (RUGS) payment method for nursing home services with Family Care members (PDF, 67 KB)
- CIB #2009-1: Payment of Nursing Home Providers When a Family Care Member Is Also Enrolled in a Hospice Program and Receiving Hospice Care Services in a Nursing Home (PDF, 86 KB)
- Calendar Year DD Center Rates for MCOs
- Division of Quality Assurance - Nursing Homes introduction
- Nursing Home Reimbursement webpage
- Methods of Implementation and Medicaid Handbook:
- Methods Of Implementation For Wisconsin Medicaid Nursing Home Payment Rates (ForwardHealth portal)
- Medicaid Online Handbook (ForwardHealth portal)
- Notes regarding Methods of Implementation and Medicaid Handbook:
- The Methods of Implementation represent the most current program requirements and rules relative to nursing home and ICF-IID provider reimbursement.
- Providers should continue to refer to the handbook for program requirements and rules.
- Because the Methods of Implementation are updated every year, and the handbook is not, providers may identify sections where the two documents are not identical. In every instance, the Methods are considered authoritative.
- As an example, the handbook contains certain obsolete references to bed hold billing requirements. Providers will see the correct current bed hold requirements in section 1.500 of the Methods.