​​​​Intermediate Care Facilities

Developmentally Disabled (ICF/DD), Habilitative​​ (ICF/DD-H), Nursing (ICF/DD-N)

Effective August 1, 2021, in accordance with Assembly Bill 133 (Chapter 143, Statutes of 2021) the reimbursement rates for ICF/DD, ICF/DD-H, and ICF/DD-N facilities will be determined without applying any reduction, limitation, or increase, including the 3.7-percent increase, imposed by Welfare and Institutions Code sections 14105.191 and 14105.192. The reimbursement rates for these facilities will be established at the 65th percentile of the group's projected costs, including the projected cost of complying with new state or federal mandates and the quality assurance fee. The reimbursement rate will be inclusive of the Proposition 56 supplemental payment per diem amount received, if the Budget Act for that fiscal year appropriates funds for Proposition 56 supplemental payments.

Additionally, for dates of service August 1, 2021 through July 31, 2022, the reimbursement rates shall be the greater of the facility's new rate established as described above inclusive of Proposition 56 supplemental payments, or the approved Medi-Cal State Plan reimbursement rate temporarily increased during the COVID-19 Public Health Emergency, plus the Proposition 56 supplemental payment in effect for the facility on July 31, 2021.

There are no changes to the billing process. For claims billed with dates of service between August 1, 2021 and July 31, 2022, providers should continue to bill the rate year (RY) 2021-22 temporary increased COVID-19 rate, until the COVID-19 Public Health Emergency ends. Proposition 56 supplemental payments will continue automatically for eligible claims, as applicable. Retroactive payment adjustments will automatically be made as necessary by the fiscal intermediary through an Erroneous Payment Correction (EPC). No additional action will be necessary on the providers' part. 

Temporary COVID-19 Increased Rates​

2021-22 ICF/DD Temporary Rates - Effective August 1, 2021

2020-21 ICF/DD Temporary Rates - Effective August 1, 2020

​ICF/DD Proposition 56 Supplemental Payments

Effective August 1, 2021, providers will continue to receive a single reimbursement payment that consists of the current per diem rate inclusive of the applicable supplemental payment amount shown below. The applicable supplemental payment amount is automatically accounted for in the facility's total reimbursement for claims meeting the supplemental payment criteria. An Erroneous Payment Correction will be processed and retroactive payment adjustments will be made automatically by the fiscal intermediary as applicable. No additional action will be necessary on the providers' part.

Proposition 56 Supplemental Payment Per Diem Amounts 

Facility
Peer Group
Accommodation Codes
(Regular Services)
Accommodation Codes
(Bed Hold Services)
Supplemental Payment Per Diem​
ICF/DD 1-59 Beds
 41
43
$15.47
ICF/DD 60+ Beds
 41
43
$0.00
ICF/DD-H 4-6 Beds
 61
63
$10.75
ICF/DD-H 7-15 Beds
 65
68
$0.00
ICF/DD-N 4-6 Beds
 62
64
$12.47
ICF/DD-N 7-15 Beds
 66
69
$22.30

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Last modified date: 12/17/2021 4:44 PM