​​​​​Attachments, Supplements and Appendix to Section 4.19 - Payment for Services

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Attachment 4.19-A

Attachment 4.19-A  Methods and Standards for Establishing Payment Rates - Inpatient Hospitals (pages 1-54)

• Definitions (pgs. 1-1.9)

• Reimbursement Limits (pgs. 2-16a) 

• Classification of Fixed and Variable Costs (pgs. 17-37)

• Disproportionate Share Hospitals (pgs. 18-37B) 

• Reimbursement for Short-Doyle/Medi-Cal Acute Inpatient Services (pgs. 38-51)

• Payment Adjustment For Provider-Preventable Conditions (pgs. 52-54) 

  Supplements to Attachment 4.19-A 

• Supplement 1  Section 1902(a)(13)(A) of the Social Security Act Compliance

• Supplement 2  Supplemental Reimbursement For Inpatient Hospital Services

Appendix to Attachment 4.19-A

• Appendix 1   Government-Operated Hospitals Approved by CMS

• Appendix 2   Prior DSH Methodology in Effect As of 2004-05 Payment Adjustment Year

• Appendix 3   Supplemental Reimbursement for Hospital Inpatient Services

• Appendix 4   Supplemental Reimbursement for Hospital Inpatient Services

• Appendix 5   Supplemental Reimbursement for Hospital Inpatient Services

Attachment 4.19-B 

Attachment 4.19-B Methods and Standards Used for Payment of Facility Services Except Inpatient Hospital, Nursing

Facility Services and Services in Intermediate Care Facilities for the Mentally Retarded (pages 1-77)  

• Methodology for Establishing Payment Rates (pgs. 1-5) 

• Targeted Case Management (pgs. 5a-5k) 

• Federal Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)  (pgs. 6-6V) 

• Payment of LEA Services and Payment for Home Health Agency Services (pgs. 20-20a)

• Reimbursement for Short-Doyle/Medi-Cal Services, SMA Methodology, and Medi-Cal Personal Care Services (pgs. 21-37)

• Reimbursement for Drug Medi-Cal Services (pgs. 38-41)

• Reimbursement Methodology For Sign Language Interpreter Services For the Hearing-Impaired and Supplemental Reimbursement for the Outpatient General Acute Care Hospital (pgs. 43-51c)

• Reimbursement for Eligible Goverment-Operated Hospitals For Professional Services (pgs. 52-65)

• Community First Choice Option Services (page 66)

• Payment Adjustment for Provider-Preventable Conditions (pgs. 67-68)

• 1915i Home and Community Based Services - Description of Rate Methodologies (pgs. 69-77)

Adding New Pages to the State Plan Pending Approval (pgs. 78-80)

Adding New Page to the State Plan Pending Approval (pg. 81)

Supplements to Attachments 4.19-B

• Supplement 1    Payment of Medicare Part A, B, and C Deductible/Coinsurance

• Supplement 2    Payment Methodology for Prescription Drugs

• Supplement 3    Federal Financial Participation Under New Federal Drug Rebate Program 

• Supplement 4    Policy and Methods for Establishing Payment Rates

• Supplement 5    Cost-Based Reimbursement

• Supplement 6    Reimbursement for Indian Health Services and Tribal 638 Health Facilities

• Supplement 7    Provider Based Rural Health Clinics

• Supplement 8    Payment for Local Education Agency (LEA) Services

• Supplement 9    Reimbursement to State-Owned Health Care Clinics For Medi-Cal Beneficiaries

• Supplement 10  Public Freestanding Outpatient Clinics Supplemental Payment

• Supplement 12  Supplemental Reimbursement for Hospital Outpatient Services

• Supplement 13  Supplemental Reimbursement for Hospital Outpatient Services

• Supplement 14  Supplemental Reimbursement for Hospital Outpatient Services

• Supplement 15  Outpatient Providers Subject to Provider Payment Reductions

• Supplement 16  Reimbursement for Emergency Air Medical Transportation Services

Attachment 4.19-C 

• ATTACHMENT 4.19-C   Payments for Reserved Beds (PDF)

Attachment 4.19-D 

• ATTACHMENT 4.19-D  Methods and Standards for Payment Rates - Skilled Nursing and Intermediate Care Facility Services (PDF)

Supplements to Attachment 4.19-D

• Supplement 2  Study to Determine Subacute Cost-Based Reimbursement

• Supplement 3  Study to Determine Rates For Transitional Inpatient Care

• Supplement 4  Methods & Standards for Establishing Facility-Specific Reimbursement Rates For Freestanding Nursing Facilities

Appendix to Attachment 4.19-D 

• Appendix 2 

• Appendix 3 

• Appendix A 

• Appendix B 

• Appendix C 

• Appendix D 

Attachment 4.19-E 

• ATTACHMENT 4.19-E   Timely Payment of Claims - Definition of a Claim by Type of Services

Attachment 4.19-F

•  ATTACHMENT 4.19-F  Monitoring Access to Medi-Cal Covered Healthcare Services