Final Revised Nursing Home Billing Rates — Effective July 1, 2026
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Governs calculation and distribution of revised Medicaid nursing home billing rates effective July 1, 2026, for Georgia Medicaid nursing facility providers; explains appeals, corrected PDPM resident listings, and rate calculation inputs.
Final nursing home billing rates calculated from the audited 2024 Medicaid cost report and effective July 1, 2026.
Case mix index and BIMS scores from corrected PDPM 'Listing of Residents' for March 31, 2026 were used to compute revised facility rates.
Base period overall PDPM calculation utilized SFY 2024 BIMS scores (Qtr. Ending Sept 30, 2023 - June 30, 2024).
Rate Calculation and Appeals Criteria
Rate calculation and appeals criteria
Criteria and processes governing the revised billing rates, use of audited data and PDPM-derived measures, and the appeals/reconsideration process.
Payment Model Inputs and Audit Period
| PDPM | Patient Driven Payment Model resident listings and case mix index/BIMS scores used in rate calculation |
Access to Revised Rates and Appeals Submission
Access revised rates and corrected resident listings
Access the Department website to download your facility’s revised billing rate sheet and, when notified by Myers and Stauffer, download the corrected PDPM “Listing of Residents.” If you cannot access the Web Portal to electronically download your listing, contact the Office of Reimbursement at nhpassword@dch.ga.gov.
- Revised billing rate sheet available at https://dch.georgia.gov/providers/provider-types/nursing-home-providers/reimbursement-rates.
- Myers and Stauffer will email providers when the corrected PDPM 'Listing of Residents' is available for download.
- Contact nhpassword@dch.ga.gov for Web Portal access issues.
Submit appeals and reconsideration requests by August 9, 2026
Submit written requests for reconsideration or appeal electronically to nh.appeals@dch.ga.gov by August 9, 2026, following Appendix Q.C procedures and including supporting documents or other evidence addressing each disputed disallowance or point of dispute.
- Appeal must follow procedures in Appendix Q.C of the Policies and Procedures for Nursing Services manual.
- The written request must address all questioned disallowance(s) and be accompanied by supporting documents or other evidence.
- Appeal requests and supporting documents must be emailed to nh.appeals@dch.ga.gov by August 9, 2026; otherwise DCH's calculation will not be reconsidered.
Key Terms
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