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 email@example.com, 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).
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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 firstname.lastname@example.org 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 email@example.com.
Quality and Accountability Payment Program