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) (PDF)

Reimbursement Limits (pgs. 2-16a) (PDF)

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

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

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

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

 Supplements to Attachment 4.19-A 

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

Supplement 2  Supplemental Reimbursement For Inpatient Hospital Services (PDF)

                              Appendix to Attachment 4.19-A

                              Appendix 1   Government-Operated Hospitals Approved by CMS (PDF)

                              Appendix 2   Prior DSH Methodology in Effect As of 2004-05 Payment Adjustment Year (PDF)

                              Appendix 3   Supplemental Reimbursement for Hospital Inpatient Services (PDF)

                              Appendix 4   Supplemental Reimbursement for Hospital Inpatient Services (PDF)

                              Appendix 5   Supplemental Reimbursement for Hospital Inpatient Services (PDF)

                               

                                                                                                                              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) (PDF)

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

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

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

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

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

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

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

                                                                                                                              Community First Choice Option Services (page 66) (PDF)

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

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

                                                                                                                              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 Attachment 4.19-B 

                                                                                                                              Supplement 1    Payment of Medicare Part A, B, and C Deductible/Coinsurance (PDF)

                                                                                                                              Supplement 2    Payment Methodology for Prescription Drugs (PDF)

                                                                                                                              Supplement 3    Federal Financial Participation Under New Federal Drug Rebate Program (PDF)

                                                                                                                              Supplement 4    Policy and Methods for Establishing Payment Rates (PDF)

                                                                                                                              Supplement 5    Cost-Based Reimbursement (PDF)

                                                                                                                              Supplement 6    Reimbursement for Indian Health Services and Tribal 638 Health Facilities (PDF)

                                                                                                                              Supplement 7    Provider Based Rural Health Clinics (PDF)

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

                                                                                                                              Supplement 9    Reimbursement to State-Owned Health Care Clinics For MEdi-Cal Beneficiaries (PDF)

                                                                                                                              Supplement 10  Public Freestanding Outpatient Clinics Supplemental Payment (PDF)

                                                                                                                              Supplement 11 

                                                                                                                              Supplement 12  Supplemental Reimbursement for Hospital Outpatient Servcies (PDF)

                                                                                                                              Supplement 13  Supplemental Reimbursement for Hospital Outpatient Services (PDF)

                                                                                                                              Supplement 14  Supplemental Reimbursement for Hospital Outpatient Services (PDF)

                                                                                                                              Supplement 15  Outpatient Providers Subject to Provider Payment Reductions (PDF)

                                                                                                                              Supplement 16  Reimbursement for Emergency Air Medical Transportation Services (PDF)

                                                                                                                              Supplement 17

                                                                                                                               

                                                                                                                              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 (PDF)

                                                                                                                              Supplement 3  Study to Determine Rates For Transitional Inpatient Care (PDF)

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

                                                                                                                              Appendix to Attachment 4.19-D 

                                                                                                                              Appendix 2  PDF

                                                                                                                              Appendix 3  PDF

                                                                                                                              Appendix 4  PDF

                                                                                                                              Appendix A  PDF

                                                                                                                              Appendix B  PDF

                                                                                                                              Appendix C  PDF

                                                                                                                              Appendix D  PDF

                                                                                                                              Attachment 4.19-E 

                                                                                                                              ATTACHMENT 4.19-E  Timely Payment of Claims - Definition of a Claim by Type of Services (PDF) 

                                                                                                                               

                                                                                                                              Attachment 4.19-F

                                                                                                                               ATTACHMENT 4.19-F  Monitoring Access to Medi-Cal Covered Healthcare Services (PDF)

                                                                                                                               

                                                                                                                               

                                                                                                                                 

                                                                                                                                 

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                               

                                                                                                                              Last modified date: 5/30/2013 10:38 AM