Medi-Cal Long-Term Care Reimbursement
The California Department of Health Care Services (DHCS) Fee For Service Rates Development Division establishes Medi-Cal reimbursement rates for the following long-term care (LTC) facilities:
• Freestanding Skilled Nursing Facilities – Level B (FS/NF-B)
• Freestanding Adult Subacute Units - Level B (FS/SA)
• Freestanding Pediatric Subacute (FS/PSA)
• Distinct Part Pediatric Subacute (DP/PSA)
• Distinct Part Skilled Nursing Facilities (DP/NF-B)
• Distinct Part Adult Subacute Units (DP/SA)
• 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)
• Nursing Facility – Level A (NF-A)
• Rural Swing Beds (RSB)
• Transitional Inpatient Care Administrative Days – Level 1 (Admin Day)
• Hospice Care
The Medi-Cal LTC reimbursement rates are established under the authority of Title XIX of the federal Social Security Act. The specific methodologies are described in the California State Plan, Attachment 4.19-D.
Latest News
Updated 5/9/2024
LTC Claim Form and Code Conversion - Effective
February 1, 2024, the Department of Health Care Services (DHCS) will retire the
use of the Long Term Care (LTC) local service codes and the Payment Request for
Long Term Care (25-1) local form. These local procedure codes will be replaced
by National Uniform Billing Committee (NUBC) data elements and the UB-04 claim
form or an electronic 837I claim transaction. DHCS has updated CY 2024 rate tables to include the new NUBC data elements - Value Code, Value Code Amount, and Revenue Code.
- DHCS is improving the usability of the Medi-Cal Long-Term Care Reimbursement webpage. Additional page updates coming soon.
CalAIM Long-Term Care Carve-In Transition
Under CalAIM, Medi-Cal managed care plans (MCPs) will cover and coordinate Medi-Cal institutional LTC in all counties in 2023 in a phased approach by facility type.
Detailed information about the transition can be found on the CalAIM Long Term Care Carve-In Transition webpage.
Rates and Policy Information
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 facilities are impacted by the rate freeze only:
- Rural Swing Bed rates for Hospitals without a DP/NF-B
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