Public Health will amend the Guam Medicaid State Plan reimbursement methodology for skilled nursing facility by: providing payments to skilled nursing facilities based on a per diem rate developed based on total Medicaid payments made for fiscal 2019, divided by total Medicaid days paid for the same period; applying an inflation factor change increase in the levels from fiscal 2019 to fiscal 2021; each fiscal year thereafter, Guam Medicaid will adjust the per diem with an annual inflation factor equal to the change in Centers for Medicare & Medicaid Services skilled nursing facility market basket index levels between the current and upcoming fiscal years.