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Long-Term Care Reimbursement AB 1629

The Long-Term Care System Development Unit establishes the Medi-Cal reimbursement rates for Freestanding Skilled Nursing Facilities Level-B (FS/NF-B), Adult Freestanding Subacute Facilities Level-B (FSSA/NF-B), NF-Bs designated as Institutions for Mental Diseases (IMD), Distinct Part Pediatric Subacute (DP/PSA) and Freestanding Pediatric Subacute Facilities Level B (FS/PSA).  

 

Update - December 6, 2016

Second Certification Document for Reimbursement for Additional Cost(s) Due to ACA Employer Shared Responsibility Mandate

The Department of Health Care Services (DHCS) is providing facility specific reimbursement by way of an add-on to the Medi-Cal reimbursement rate for the additional cost of health care coverage solely due to Employer Shared Responsibility requirements in the ACA embodied in Section 4980H of the Internal Revenue Code (IRC).
 
Effective in the 2016 – 2017 Rate Year, the Department of Health Care Services (DHCS) is providing a facility specific reimbursement.  A provider may submit the Second Certification Form for reimbursement if it was not an Applicable Large Employer (ALE) in 2015, but in 2016, it became an Applicable Large Employer as defined by section 4980H and its implementing regulations, and if the provider incurred additional costs due to this ACA requirement.  A provider may also submit the Second Certification Form with actual differences in 2016 insurance costs incurred if it was an Applicable Large Employer in 2015 and submitted the first ACA Certification Form. The deadline for submitting requests for the add-on is February 28, 2017.
 
The add-on will apply to the following facilities:
·         Free-Standing Skilled Nursing Facilities Level B (NF-B)
·         Free-Standing Adult Subacute
·         Nursing Facilities Level A (NF-A)
·         Distinct-Part Nursing Facilities Level B (DP/NF-B)
·         Rural Swing Beds
·         Distinct-Part Adult Subacute
·         Distinct-Part Pediatric Subacute
·         Free-Standing Pediatric Subacute
·         Intermediate Care Facilities for the Developmentally Disabled (ICF/DD)
·         Intermediate Care Facilities for the Developmentally Disabled/Habilitative (ICF/DD-H)
·         Intermediate Care Facilities for the Developmentally Disabled/Nursing (ICF/DD-N)
 
To qualify to receive an add-on, providers need to submit a Second Certification Form verifying that the employer is an ALE as defined by IRC Section 4980H (and its implementing regulations and guidance) and has incurred additional health care coverage costs solely as a result of the ACA Employer Shared Responsibility provision. This is a two year add-on to the rate until the ACA mandated health care coverage costs are in the facility’s cost report. 
 
 
Providers may submit the Certification Form electronically to supp1629@dhcs.ca.gov with the subject line “2016-2017 ACA Certification Form” along with their facility’s NPI or OSHPD number (for example, “ACA Certification Form 206xxxxxx”). Providers who are not able to submit electronically can mail a signed copy of the certification form to: 
Department of Health Care Services
Fee-For-Service Rates Development Division
Long Term Care Section
ACA Second Cert Form
P.O. Box 997417, Ste. 71.3052, MS 4600
Sacramento, CA  95899-7417
This information must be received by DHCS no later than February 28, 2017. For assistance, providers can contact the Long Term Care System Development Unit at supp1629@dhcs.ca.gov.
 

Update - October 31, 2016

The California Medicaid Management Information System Division (CA-MMIS) has completed a system update that enables Distinct Part Pediatric Subacute facilities to bill their full per diem rate to Medi-Cal. On a prospective basis, these facilities should bill their full rate instead of billing $990 with a separate bill for the remainder.

 

Update - October 19, 2016

Senate Bill (SB) 3 Minimum Wage Impact Survey to Long-Term Care (LTC) Providers

SB 3 Minimum Wage Survey FAQs (PDF) Updated 11/9/16

 

Effective in the 2016 – 2017 Rate Year, the Department of Health Care Services (DHCS) is providing reimbursement to LTC providers by way of an add-on to the Medi-Cal reimbursement rate for the additional cost of minimum wage increase due to Senate Bill 3 (2016).

 
To provide accurate reimbursement, DHCS requests the participation of long-term care providers to complete the SB 3 Wage Survey.  Please refer to the Survey Instructions (PDF) via the link below for important information before you complete the survey.  If you are not the person in your organization responsible for completing this survey, please forward these instructions and the survey link to the appropriate staff.  The survey will be open through January 15, 2017.
 
The Survey and Instructions are available at the link below:
 
In addition to the direct impact of SB 3, DHCS is interested in studying the indirect impact of the minimum wage increase due to the “ripple effect.” This ripple effect occurs when a raise in the minimum wage increases the wage received by workers that earned slightly above the minimum wage.  To capture the true impact of the ripple effect, DHCS requests that each facility complete the Excel document located at the link below to report all employees that made between $13.01 - $21.00 per hour during the pay period from April 1, 2016 through June 30, 2016.  The Excel document must be submitted electronically to the Long Term Care System Development Unit at supp1629@dhcs.ca.gov or LTCReimbursement@dhcs.ca.gov (Intermediate Care Facilities for the Developmentally Disabled [ICF-DDs] only) with the subject line “SB 3 Ripple Effect Survey” no later than January 15, 2017.
 
If you are not able to submit the excel document electronically, please print and mail a signed copy of the Excel document to:
Department of Health Care Services
Fee-For-Service Rates Development Division
Long Term Care Section
SB 3 Ripple Effect Survey
P.O. Box 997417, Ste. 71.3052, MS 4600
Sacramento, CA  95899-7417
 
If you have any questions or concerns, please contact the Long Term Care System Development Unit at supp1629@dhcs.ca.gov or LTCReimbursement@dhcs.ca.gov (ICF-DDs only) with the subject line “SB 3 Wage Impact Survey”.
 

 Update - July 15, 2016

The final 2015-16 FS/NF-B rates are completed.

Update - January 5, 2016

Interim rates were uploaded by the fiscal intermediary on January 25, 2016. 
Interim reimbursement rates for FS/NF-Bs have been established for the 2015/16 rate year. Because these are interim rates, no retroactive payments will be processed. Retroactive payments will be made once the final 2015/16 rates are loaded. We have instructed Xerox State Healthcare, LLC (Xerox) to install rates.
If you have rate questions, please e-mail us at ab1629@dhcs.ca.gov, or leave a voice message at (916) 552-8613.
If you have questions regarding your Erroneous Payment Correction (EPC), please contact Xerox at (800) 541-5555 (outside of California, please call 916-636-1980).
NOTE: Some links on this page are documents in Adobe Acrobat Portable Document Format (PDF). PDF documents require Adobe Reader. If you need to install or upgrade to the latest version, click “Download Free Readers”. 

Update - December 7, 2015

New Facility Specific Add-on for the Additional Cost(s) Due to ACA Employer Shared Responsibility Mandate

ACA Employer Mandate Certification Form FAQs (PDF) Updated 1/8/16

 

The following article initially published with a form submission deadline of January 15, 2016.  The form submission deadline has been extended until February 29, 2016. 

 

Effective in the 2015 – 2016 Rate Year, the Department of Health Care Services (DHCS) is providing facility specific reimbursement by way of an add-on to the Medi-Cal reimbursement rate for the additional cost of health care coverage solely due to Employer Shared Responsibility requirements in the ACA embodied in Section 4980H of the Internal Revenue Code (IRC). The add-on will apply to the following facilities:

  • Free-Standing Skilled Nursing Facilities Level B (NF-B)
  • Free-Standing Adult Subacute
  • Nursing Facilities Level A (NF-A)
  • Distinct-Part Nursing Facilities Level B (DP/NF-B)
  • Rural Swing Beds
  • Distinct-Part Adult Subacute
  • Distinct-Part Pediatric Subacute
  • Free-Standing Pediatric Subacute
  • Intermediate Care Facilities for the Developmentally Disabled (ICF/DD)
  • Intermediate Care Facilities for the Developmentally Disabled/Habilitative (ICF/DD-H)
  • Intermediate Care Facilities for the Developmentally Disabled/Nursing (ICF/DD-N)

 

To qualify to receive an add-on, providers need to submit a Certification Form verifying that the employer is an ALE as defined by IRC Section 4980H (and its implementing regulations and guidance) and has incurred additional health care coverage costs solely as a result of the ACA Employer Shared Responsibility provision. This is a two year add-on to the rate until the ACA mandated health care coverage costs are in the facility’s cost report.

 

Providers may submit the Certification Form electronically to supp1629@dhcs.ca.gov with the subject line “ACA Certification Form” along with their facility’s OSHPD number (for example, “ACA Certification Form 206xxxxxx”). Providers who are not able to submit electronically can mail a signed copy of the certification form to: 

Department of Health Care Services

Fee-For-Service Rates Development Division

Long Term Care Section

ACA Cert Form

P.O. Box 997417, Ste. 71.3052, MS 4600

Sacramento, CA  95899-7417 

This information must be received by DHCS no later than January 15, 2016. For assistance, providers can contact the Long Term Care System Development Unit at supp1629@dhcs.ca.gov. 

 Helpful Links

Quality and Accountability Payment Program

Prior Years Rates
Last modified on: 12/5/2016 4:15 PM