Please see the important information below regarding the hold harmless provision implemented by the Department of Health Services (DHS) to address the transition from RUGs to PDPM. More detailed information about the provision itself and how to view your facility’s report are described below.

The state fiscal year (SFY) 2023 Nursing Home Methods of Implementation included a hold harmless provision in which facilities would be reimbursed for any rate reduction in excess of $2 per patient day resulting from the transition from Resource Utilization Groups (RUGs) to patient driven payment model (PDPM) acuity systems. This email has information about payments for quarter 3 (Q3) and Q4 2022.

The purpose of the reports is to calculate additional payments due to providers that had per diem payments under the PDPM less than they would have been under the RUGS system. Federal data as of March 31, 2023, was used for the Q3 2022 report. Federal data as of June 30, 2023, was used for the Q4 2022 report.

Providers eligible for payments had an average daily decrease of more than $2 per patient day, per the hold harmless provision, SFY 2023 Methods Section 2.60.

• If your facility is eligible for a revised Q3 payment, you will receive the Q3 report under the “Hold Harmless Report” event on your Wisconsin Nursing Home Rate Setting (WINHRS) stat log for fiscal year ending 2021.
• If your facility is eligible for a Q4 payment, you will receive the Q4 report under the “Hold Harmless Report” event on your WINHRS stat log for fiscal year ending 2021.
• If your facility is not eligible for payment, you may request a copy of your report by emailing WINHRSHelpDesk@mslc.com. Include your POP ID in the request.

DHS will issue payments to facilities for services rendered by fee-for-service providers, as per the facility’s report. Managed care organizations (MCOs) are required to submit payments to facilities for services rendered by their network providers. MCOs have been provided a report detailing how much they owe each facility.

If you believe a calculation has been made in error, contact your assigned auditor before November 27, 2023. We will issue payments and full recoupments no earlier than November 27, 2023. Payments will be processed via ForwardHealth and will show up in your facility’s remittance advice.