Nursing Home Reimbursement

Medicaid Nursing Home fee-for-service rate setting and reimbursement is governed by the authority of Wis. Stat. §. 49.45(6m). The Division uses a methodology described in Wisconsin's State Medicaid Plan attachment 4.19-D, the Methods of Implementation for Wisconsin Medicaid Nursing Home Payment Rates.

Cost Report

Online Reimbursement System (ORBS) Cost Reporting System

Providers use this site to complete the annual cost report. Cost report templates that are downloaded from the ORBS system can pre-populate some required data fields.

ORBS Training

Training Video

Training PowerPoint Slides (PDF, 1 MB)

Apply for ORBS Access

Only users authorized by providers may submit an annual cost report to the ORBS. To request access to ORBS, please complete the form below and send it to Greg Leighty.

User Access form - F-01477 (Word, 20 KB)

 Blank Forms and Instructions

Below is a link to the 2016 Cost Report that that will not pre-populate any required data fields. Do not use for 2017 Cost Report submissions. To complete your annual Cost Report, log onto the ORBS website and download the template from that site.

  • Cost Report (Excel, 3 MB)
  • For Cost Report instructions, see Cost Report tab "CR Instructions"

Due Date Reminder

  • The completed Cost Report must be submitted to ORBS within three months after the end of the cost reporting period.
  • Facilities that had a certified audit for the cost reporting period are permitted an additional 30 days from the due date specified above to file the Cost Report. A copy of the audit report must be submitted with the Cost Report.
  • A provider who fails to complete and submit the Cost Report by the above dates may be subject to a daily forfeiture as provided in Wis. Stat. §. 49.45(13)(b).

Obtaining an electronic copy of a Cost Report

Completed Cost Reports may be downloaded free of charge from the ORBS Website. A user ID and login password are not required to access PDF copies of Cost Reports submitted by providers beginning in the 2014 Cost Report year. Although unaudited, preliminary, and provided "as is," Cost Reports are public records.

Requesting a copy of a previous Cost Report (2013 and earlier)

Email requests for a copy of older Cost Reports are processed as timely as possible, typically within three to 10 business days. The processing fee is 15¢ per page for 2013 and earlier cost reports, plus shipping and handling. Once the Cost Reports are copied and ready to ship, the requesting agency will be contacted with the amount due. The amount due is payable via check to the Division of Medicaid Services and once payment is received, the copies will be shipped. There is no shipping charge when the requesting agency picks up the reports.

Information to be included in the email request:

  • Facility name
  • Cost Report year
  • Whether for pick-up or to be mailed
  • Mailing address

Requests for Cost Report copies can be sent via email to the Bureau of Long Term Care Financing.

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”.
  • If you do not know who your portal administrator is, please contact Brandon Barlow.
  • 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.

 

Public Provider Meeting Information

Upcoming meeting dates 
  • Monday, May 1, 2017  
  • Wednesday, July 12, 2017 
  • Wednesday, August 23, 2017 

All meetings will be held from 10 a.m. to 12 p.m. at the Department of Health Services, 1 W. Wilson St., Madison, WI, Room 751. 
Please allow sufficient time for parking and checking in at our visitor desk. Call-in option available: 1-877-820-7831, Passcode 393306

Previous meeting dates
  • On Tuesday, August 30, 2016, the Department of Health Services hosted a nursing home industry public meeting with a focus on "Wisconsin Medicaid Nursing Facility Payment Methods." 

Agenda (PDF, 33 KB)
Presentation (PDF, 92 KB)
Nursing Home Rate Modeling (PDF, 427 KB)

  • On Wednesday, June 22, 2016, the Department of Health Services hosted a nursing home industry public meeting with a focus on "Wisconsin Medicaid Nursing Facility Payment Methods."

Agenda and Presentation (PDF, 431 KB)
Nursing Home Census and Case Mix History, Analysis of Change, Nursing Home Modeling Scenarios (PDF, 642 KB)

  • On Wednesday, April 27, 2016, the Department of Health Services hosted a nursing home industry public meeting with a focus on "Wisconsin Medicaid Nursing Facility Payment Methods." 

Agenda and Presentation (PDF, 100 KB)
Nursing Home Case Mix Trend (PDF, 100 KB)
Nursing Home Census Trend (PDF, 91 KB)

Last Revised: February 15, 2017