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Long Term Care Reimbursement

The Long Term Care (LTC) Reimbursement Unit conducts the annual study to develop the Medi-Cal rates for a variety of long-term care providers. This study serves as the basis for Medi-Cal reimbursements of Nursing Facilities including Nursing Facility - Level A (NF-A), Distinct Part Skilled Nursing Facilities of General Acute Care Hospitals (DP/NF-Bs), Distinct Part Adult Subacute Units for General Acute Care Hospitals (DP/SA), Hospice Care, Rural Swing Beds, Acute and Transitional Inpatient Care Administrative Days (Administrative Days Level 1) and Intermediate Care Facilities for the Developmentally Disabled
(ICF-DD) (including ICF/DD-Habilitative and ICF/DD-Nursing).  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 Centers for Medicare and Medicaid Services (CMS). 

Latest News

ICF/DD Prop 56 Supplemental Payment News

Update - April 5, 2018

On March 26, 2018, the Department of Health Care Services (DHCS) implemented the Proposition 56 supplemental payment for Intermediate Care Facilities for the Developmentally Disabled, including Habilitative and Nursing facilities, effective for dates of service August 1, 2017, through July 31, 2018.
Providers will receive a single reimbursement payment that includes the current per diem rate in addition to the supplemental payment amount shown below.
 
The supplemental payment amounts are automatically added to reimbursement payments for claims meeting the supplemental payment criteria. Conduent State Healthcare LLC will prepare an Erroneous Payment Correction to reprocess claims to retroactively pay the supplemental payment.
 

 ICF/DD Supplemental Payment Per Diem Amounts

Facility Peer Group ​

LTC Accommodation Code

(Regular Services)​

Behold Accommodation Code​

​Supplemental Payment

Per Diem

​ICF/DD 41 (1-59 beds)​ ​43 ​$15.47
​ICF/DD ​41 (60+ beds) ​43 ​$0.00
​ICF/DD-H ​61 (4-6 beds) ​63 ​$10.75
​ICF/DD-H ​65 (7-15 beds) ​68 ​$0.00
​ICF/DD-N ​62 (4-6 beds) ​64 ​$12.47
​ICF/DD-N ​66 (7-15 beds) ​69 ​$22.30
  • Note that facilities in peer groups in which the unfrozen 2017-18 65th percentile rate is lower than the current reimbursement rate will not receive the supplemental payment.   

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

Senate Bill (SB) 3 Minimum Wage Survey Extension

Update - March 31, 2018
The SB 3 Minimum Wage Survey deadline has been extended until April 27, 2018.  Long-term care providers can complete the survey using the Survey Monkey link below:
 
If you have any questions please email LTCReimbursement@dhcs.ca.gov (Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs, ICF/DD-Hs, & ICF/DD-Ns) only) or supp1629@dhcs.ca.gov with the subject line “SB 3 Direct Impact Survey Extension”.
Update - January 16, 2018
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 the minimum wage increase due to Senate Bill 3 (Chapter 4, Statutes of 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 March 23, 2018.
 
 The Survey and Instructions are available at the links below:
 
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, ICF/DD-Hs, ICF/DD-Ns only) with the subject line “SB 3 Wage Impact Survey”.

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 was 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 was due to DHCS no later than February 28, 2017. For assistance, providers can contact the Long Term Care System Development Unit at supp1629@dhcs.ca.gov.

Two New Facility Specific Add-Ons for LTC Reimbursement  

 
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 for dates of service on or after August 1, 2015, the following two add-ons are available for Long Term Care (LTC) facility specific reimbursement for Applicable Large Employers (ALE) to recover costs due to the Patient Protection and Affordable Care Act (ACA) Employer Shared Responsibility and Internal Revenue Service (IRS) employer reporting mandates. The deadline for submitting requests for the two  add-ons listed below is January 15, 2016.

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

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.

Reimbursement for Additional Cost(s) Due to IRS Employer Reporting Mandate

Effective in the 2015 – 2016 Rate Year, DHCS will be providing facility specific reimbursement by way of an add-on to their Medi-Cal reimbursement rate for the additional cost of complying with the reporting requirements imposed by IRC Section 6056 to report employee health coverage information to the IRS through completion of Forms 1094-C and 1905-C. The add-on will apply to the following facilities:

  • Intermediate Care Facilities for the Developmentally Disabled/Habilitative (ICF/DD-H)
  • Intermediate Care Facilities for the Developmentally Disabled/Nursing (ICF/DD-N)

 

Only the ICF/DD-H or ICF/DD-N providers that meet the ALE definition need to submit a Certification Form because the employer reporting add-on is already included in the 2015 - 2016 reimbursement rate for 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)

 

To qualify to receive an add-on, ICF/DD-H or ICF/DD-N 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 as a result of the ACA IRS employer reporting mandate.

 

Providers may submit this form electronically to LTCReimbursement@dhcs.ca.gov, with the ICF/DD-H or ICF/DD-N National Provider Identifier (NPI), the facility’s nine digit ZIP code, and “Employee Reporting Cert.” in the email subject line. The form may also be submitted by fax to 1-916-449-5337. This information must be received by DHCS no later than January 15, 2016. For additional information, providers can email LTCReimbursement@dhcs.ca.gov. 

Providers Impacted by AB 97

The following classes of providers are impacted by the rate freeze and the 10 percent payment reduction:

  • Nursing Facilities - Level A (NF-A)
     

The following are impacted by the rate freeze ONLY:

  • Rural Swing Bed rates for Hospitals without a DP/NF-B

Note

  • Adult Day Health Care has moved to the Community Based Adult Services (CBAS) program.
  • Beginning with the 2013.14 rate year, the Freestanding and Distinct Part Pediatric Subacute facility rates are established by the Long Term Care Systems Development Unit, Fee For Services Rates Development Division.  For information and rates, see the LTC AB1629 page.

Helpful Links

LTC AB1629

Facilities' Rates and Policy Information

Nursing Facility - Level A (NF-A)
Distinct PART Nursing Facility - Level B (DP/NF-B)
Administrative Day Rate Level 1
Distinct PART Adult Facilities (Adult Subacute)
Intermediate Care Facilities (Developmentally Disabled, Habilitative, and Nursing) ICF/DD
Rural Swing Bed
Hospice Care
Last modified on: 4/5/2018 2:59 PM