Long Term Care Reimbursement

The Long Term Care (LTC) Reimbursement Unit conducts the annual study to develop the Medi-Cal rates for long term care providers.  This study serves as the basis for Medi-Cal reimbursements of approximately $3 billion dollars annually for nursing facilities, intermediate care facilities, hospice care, adult day health care, subacute services, and home health agency services.  This unit also conducts the necessary research to develop new or revised reimbursement methodologies necessary to meet changing policy or program needs. 

The Medi-Cal LTC reimbursement rates are established under the authority of Title XIX of the federal Social Security Act.  The specific methodology is described in the State Plan, a document prepared by the Department and approved by the federal Health Care Financing Administration (HCFA).

• Cost Components Used to Project Costs

 Provider Specific Information:

• Distinct Part Nursing Facilities, Level B (DP/NF-B)
• Freestanding Nursing Facilities (NF-A)
• Freestanding Nursing Facilities (NF-B)
• Hospice Care
• Intermediate Care Facilities (Developmentally Disabled, Habilitative, and Nursing)
• ICF/DD Quality Assurance Fee Program
• Subacute Care Facilities - Adult (Distinct Part) and Pediatric (Distinct Part and Freestanding)