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 staff which requires approval by the Center for Medicare and Medicaid Services (CMS).
LATEST NEWS
Mandated Rate Changes For Long Term Care Providers Effective August 1, 2009
This bulletin is to provide information with respect to recently chaptered legislation which maintains Medi-Cal rates in effect as of March 1, 2009, for the classes of providers identified below. Health Trailer Bill ABx4 5 (Statutes of 2009) continues the level of reimbursement in effect for 2009–2010 rate year, and each year thereafter, at the rates applicable to those classes of providers for the 2008–2009 rate year. This mandate applies to the following classes of providers:
· Nursing Facilities – Level A (NF-A)
· Intermediate Care Facilities for the Developmentally Disabled (including Habilitative and Nursing)
· Skilled Nursing Facilities that are distinct parts of General Acute Care Hospitals
· Rural Swing Bed Facilities
· Subacute Care Units, that are, or are parts of, distinct parts of General Acute Care Hospitals
· Pediatric Subacute Care Units that are, or are part of, distinct parts of General Acute Care Hospitals
· Freestanding Pediatric Subacute Care Units
· Adult Day Health Care Centers
ABx4 5 in effect “freezes” Medi-Cal reimbursement rates, and is subject to any pending judicial determination regarding the level of the rates in effect for the 2008–2009 rate year, made by any state, federal or appellate court that is final and is not further appealed.
Cost Components Used to Project Costs
Provider Specific Information: