Family Care: Nursing Home Resources
This page includes nursing home benefit resources for Family Care, Partnership, and/or PACE (Program of All-Inclusive Care for the Elderly) managed care organizations (MCOs).
Nursing home rates
Family Care MCO Rates by PDPM Category
If a provider is not listed on the rate worksheet for the current state fiscal year (SFY), please use the worksheet from the prior SFY (which is included in the same workbook) as interim rates. The rate workbook will be updated at least monthly until final rates for all homes are completed. If you have any questions, please contact DHSDMSBRS@dhs.wisconsin.gov.
Memos and technical assistance
- 11-02 MCO Access and Contracts with Nursing Home Commissions formed under s. 49.49(7) (PDF)
- Changes to Coverage, Daily Rate, and Billing Instructions for Negative Pressure Wound Therapy Pumps for Nursing Homes
- 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)
Other resources
- 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.