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Long Term Care Reimbursement

The Long Term Care (LTC) Reimbursement Unit conducts the annual study to develop the Medi-Cal rates for a variety of long-term care providers. This study serves as the basis for Medi-Cal reimbursements of Nursing Facilities including Nursing Facility - Level A (NF-A), Distinct Part Skilled Nursing Facilities of General Acute Care Hospitals (DP/NF-Bs), Distinct Part Adult Subacute Units for General Acute Care Hospitals (DP/SA), Hospice Care, Rural Swing Beds, Acute and Transitional Inpatient Care Administrative Days (Administrative Days Level 1) and Intermediate Care Facilities for the Developmentally Disabled
(ICF-DD) (including ICF/DD-Habilitative and ICF/DD-Nursing).  This unit also conducts the necessary research to develop new or revised reimbursement methodologies necessary to meet changing policy or program needs.

The Medi-Cal LTC reimbursement rates are established under the authority of Title XIX of the federal Social Security Act.  The specific methodology is described in the State Plan, a document prepared by the Department staff which requires approval by the Centers for Medicare and Medicaid Services (CMS). 

Latest News

  1. ICF/DD Prop 56 Supplemental Payment
  2. 2018 Wage Survey

ICF/DD Prop 56 Supplemental Payment News

Update - April 5, 2018

On March 26, 2018, the Department of Health Care Services (DHCS) implemented the Proposition 56 supplemental payment for Intermediate Care Facilities for the Developmentally Disabled, including Habilitative and Nursing facilities, effective for dates of service August 1, 2017, through July 31, 2018.
Providers will receive a single reimbursement payment that includes the current per diem rate in addition to the supplemental payment amount shown below.
 
The supplemental payment amounts are automatically added to reimbursement payments for claims meeting the supplemental payment criteria. Conduent State Healthcare LLC will prepare an Erroneous Payment Correction to reprocess claims to retroactively pay the supplemental payment.
 

 ICF/DD Supplemental Payment Per Diem Amounts

Facility Peer Group ​

LTC Accommodation Code

(Regular Services)​

Behold Accommodation Code​

​Supplemental Payment

Per Diem

​ICF/DD 41 (1-59 beds)​ ​43 ​$15.47
​ICF/DD ​41 (60+ beds) ​43 ​$0.00
​ICF/DD-H ​61 (4-6 beds) ​63 ​$10.75
​ICF/DD-H ​65 (7-15 beds) ​68 ​$0.00
​ICF/DD-N ​62 (4-6 beds) ​64 ​$12.47
​ICF/DD-N ​66 (7-15 beds) ​69 ​$22.30
  • Note that facilities in peer groups in which the unfrozen 2017-18 65th percentile rate is lower than the current reimbursement rate will not receive the supplemental payment.   

2018 Wage Survey

The Department of Health Care Services (DHCS) is providing reimbursement to LTC providers by way of an add-on to the Medi-Cal reimbursement rate for the additional cost of the minimum wage increase due to Senate Bill 3 (Chapter 4, Statutes of 2016). 

Update - October 1, 2018 

DHCS is conducting a survey to collect wage data beyond the minimum wage to better understand overall wage impacts to LTC facilities.  DHCS requests for LTC providers to complete the wage survey by using the link provided below:
 
Completed surveys should be submitted by November 16, 2018.  Please forward completed surveys to LTCReimbursement@dhcs.ca.gov (ICF/DDs, ICF/DD-Hs, ICF/DD-Ns, NF-As, DP/NF-Bs, & DP Adult Subacutes) with the subject line “2018 Wage Survey.”

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 are impacted by the rate freeze ONLY:

  • Rural Swing Bed rates for Hospitals without a DP/NF-B

Note

  • Adult Day Health Care has moved to the Community Based Adult Services (CBAS) program.
  • Beginning with the 2013.14 rate year, the Freestanding and Distinct Part Pediatric Subacute facility rates are established by the Long Term Care Systems Development Unit, Fee For Services Rates Development Division.  For information and rates, see the LTC AB1629 page.

Helpful Links

Facilities' Rates and Policy Information

Nursing Facility - Level A (NF-A)
Distinct PART Nursing Facility - Level B (DP/NF-B)
Administrative Day Rate Level 1
Distinct PART Adult Facilities (Adult Subacute)
Intermediate Care Facilities (Developmentally Disabled, Habilitative, and Nursing) ICF/DD
Rural Swing Bed
Hospice Care
Last modified on: 10/2/2018 4:24 PM