Nursing homes: program overview

The Rate and Audits Section is responsible for rate-setting and compliance auditing of nursing facilities, statistical information and analysis as well as rates policy development. On-site (field) audits are conducted in accordance with federal audit standards. Information generated through audits of nursing facility cost reports is used to determine payment rates for Medicaid-certified facilities. Activities of the Rates and Audits Section include; conducting desk and field audits annually, calculating annual payment rates for all Medicaid-certified nursing facilities and recalculating facility rates due to special rate adjustments and circumstances.

Provider rate files

For accuracy, the following .xlsx files should be viewed using Excel.  Save the file, then open the file through Excel.

• 2020 Rate Year (as of 10/22/20) (XLSX)
• 2019 Rate Year (as of 8/25/20) (XLSX)

The Compliance, Intergovernmental Relations and Policy Section is responsible for interpreting and ensuring compliance with state and federal regulations and policy development for nursing facilities, boarding care homes and nursing facility institutions for persons with mental disease (NF/IMDs). 

Issues addressed by this section include civil monetary penalties, survey, and certification, NF/IMD audits, emergency management and preparedness, discrimination, resident rights, state and federal regulations and federal relations.

The Contracts Management section is responsible for contracting with individual nursing facilities for services, the nursing home report card, quality indicators and adjusters and other measurements of quality purchasing, and special quality programs such the Performance-based Incentive Payment Program (PIPP).