Intermediate Care Facilities - Developmentally Disabled, Habilitative and Nursing

Reimbursement rates for Intermediate Care Facilities, Developmentally Disabled (ICF/DD), Habilitative (ICF/DD-H), and Nursing (ICF/DD-N) are updated annually using an unfrozen, peer-grouped, cost-based rate methodology in accordance with Attachment 4.19-D of the California Medicaid State Plan. Facilities are classified into peer groups by level of care and bed size. The reimbursement rates for each peer group are established at the 65th percentile of the group's projected costs based on the most recent reported and audited cost data adjusted for inflation, plus the projected cost of complying with new state or federal mandates (such as state minimum wage increases) and the Quality Assurance Fee (QAF). Effective August 1, 2022, the former Proposition 56 Supplemental Payments have transitioned to be included as part of the unfrozen, cost-based rate.

In response to the increased cost pressures incurred by facilities due to the COVID-19 Public Health Emergency (PHE), DHCS provided these facilities with a COVID-19 PHE temporary rate increase equal to 10 percent of their 2019-20 per diem rates for the duration of the PHE, as approved in State Plan Amendment 20-0024. 

In accordance with Senate Bill 184 (Chapter 47, Statutes of 2022), which amended Welfare and Institutions Code § 14105.075, DHCS is establishing a hold harmless provision for dates of service after the declared end of the PHE in the approved State Plan Amendment 22-0061. The hold harmless provision will provide that after the last day of the PHE, facilities will receive the greater of:

• The unfrozen, cost-based rate as described above, or
  
• The total reimbursement rate in effect on the last day of the PHE, inclusive of the COVID-19 PHE temporary rate increase.
  

Rates

ICF/DD Calendar Year 2025 Rates - Effective January 1, 2025 through December 31, 2025

Published 12/30/2024

Notes:

• Rate table updated in accordance with the LTC Claim Form and Code Conversion.
• The 2025 Calendar Year bed hold amount is $9.77.
  
• Managed Care organizations may refer to the Total Reimbursement and the Total Bed Hold Reimbursement amounts.

ICF/DD Calendar Year 2024 Rates - Effective February 1, 2024 through December 31, 2024

Notes:

• Rate table updated in accordance with the LTC Claim Form and Code Conversion.
• The 2024 Calendar Year bed hold amount is $9.52.
  
• Managed Care organizations may refer to the Total Reimbursement and the Total Bed Hold Reimbursement amounts.

ICF/DD Calendar Year 2024 Rates - Effective January 1, 2024 through January 31, 2024

Notes:

• The 2024 Calendar Year bed hold amount is $9.52.
  
• Managed Care organizations may refer to the Total Reimbursement and the Total Bed Hold Reimbursement amounts.

ICF/DD 2023 Bridge Period Rates - Effective August 1, 2023 through December 31, 2023

Notes:

• The 2023 Bridge Period bed hold amount is $9.46.
• Managed Care organizations may refer to the Total Reimbursement and the Total Bed Hold Reimbursement amounts.

Contact Us

Please send questions regarding ICF/DD rates to LTCReimbursement@dhcs.ca.gov.

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