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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 - 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: 7/25/2016 10:10 AM