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Policies and Guidelines

Subacute Care

         Provider Criteria for Participation in the Subacute Care Program:

  • Licensed as an acute care hospital with a distinct part (DP), skilled nursing facility (SNF), or
  • Licensed as a freestanding (FS) SNF, and
  • Certified as a long term care Medicare and Medi-Cal provider, and
  • History of compliance with the DHCS Licensing and Certification program, and
  • Professional staff with the ability to provide care to subacute patients either by experience or demonstrated competence. 
  • When a provider meets the criteria the DHCS enters into a contractual agreement to provide services to Medi-Cal subacute patients.

  • When a DP/FS SNF meets the criteria the DHCS enters into a contractual agreement, with the facility, to provide services to Medi-Cal subacute patients.

Subacute Reimbursement Rates

Daily reimbursement rates for subacute facilities vary depending on the type of the facility and whether the patient is ventilator dependent or non-ventilator dependent. Reimbursement rates for each facility are established by the DHCS Rate Development Branch and are based upon the costs of the facility up to a median rate for DP facilities and weighted averages for FS facilities.

 

Pediatric Subacute Reimbursement Rates

Daily reimbursement rates for pediatric subacute facilities vary depending on the type of the facility and whether the patient is ventilator dependent or non-ventilator dependent.  Reimbursement rates for each facility are established by the DHCS Rate Development Branch based on a model for pediatric subacute facilities.  

 

Adult Facility type

RN and LVN requirement

CNA requirement

Subacute care unit

FS

3.8

2.0

DP

4.0

2.0

 

 

 

 

 

Minimum Subacute Staff-To-Patient Ratios for Pediatric Subacute Care Units

Pediatric subacute care units must employ sufficient subacute staff, as required by subacute regulation. Staff-to-patient ratios are a minimum daily average of 5.0 unduplicated licensed nursing hours per patient day, and 4.0 certified nurse assistant hours per patient day. Additionally, Pediatric subacute care units must utilize a minimum of 3.0* respiratory care practitioner (RCP) hours for ventilator dependent patients, and 2.0* RCP hours for non-ventilator dependent patients, of medically necessary respiratory care services, when provided under the order of a person lawfully authorized to give such an order, and according to each pediatric subacute patient’s assessment and care plan.

Pediatric Patient type

RN and LVN requirement

CNA requirement

RCP requirement

Subacute care unit

Ventilator

5.0

4.0

3.0*

Non-ventilator

2.0*

Contact Information:

 

Subacute Care Unit

Department of Health Care Services

1501 Capitol Avenue, MS 4504

P.O. Box 997419

Sacramento, CA 95899-7419

Phone: (916) 552-9113 FAX: (916) 552-9109

Email: subacute2@dhcs.ca.gov

To Request Subacute Resource and Related Reference Materials:

Contact the Subacute Care Unit at the information above for the following materials, or visit the available web links below:

  • Medi-Cal Subacute Care Contract Application (adult, pediatric)
  • Application to Increase the Number of Beds in the Subacute Care Unit
  • Monthly Subacute Staffing Report electronic form and instructions guide
  • California Code of Regulations and other applicable state and federal requirements related to the Subacute Care Program.
  • Current list of contracted subacute care providers and other reference materials
  • Current subacute rates information - visit the Medi-Cal Provider Manual.
  • Medi-Cal Provider Manual for the Pediatric Subacute Care Program criteria.
  • Medi-Cal Provider Manual for the Adult Subacute Care Program criteria.
  • Medi-Cal Provider Manual for other Subacute Care Program information – visit the Medi-Cal Provider Manual - Long Term Care

Associations

California Hospital Associations

Last modified on: 5/4/2011 7:35 AM