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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. Additional Reimbursement for Fee-For-Service Hospice Room and Board Services Provided in ICF/DD Facilities

Additional Reimbursement for Fee-For-Service Hospice Room and Board Services Provided in ICF/DD Facilities

Effective for dates of service on or after August 1, 2018, the Department of Health Care Services (DHCS) will reimburse hospice providers for fee-for-service room and board services at 95 percent of the total per diem reimbursement, which will include the 2018 – 2019 facility per diem rate plus the supplemental payment per diem amount authorized by SPA 18-0029, for patients residing in an ICF/DD facility.
 
  • The additional reimbursement will be paid on a quarterly basis, beginning on December 2018, for hospice room and board service bed days rendered in the immediately preceding quarter, beginning with the quarter spanning August 1, 2018, through October 31, 2018.
  • The additional quarterly reimbursements will be paid through warrants issued by the State Controller’s Office and will be paid separately and in addition to the usual hospice room and board reimbursements paid through the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary.
  • The additional reimbursement is subject to the availability of funds. 

 

Claims submitted with Revenue Code 0658 for fee-for-service room and board services for patients residing in ICF/DDs will receive the additional reimbursement. Hospice providers should continue to bill as usual. No additional action is required of providers. DHCS may contact affected providers for additional information if needed to process reimbursements.

 

The Hospice Room and Board Additional Reimbursement per diem amounts are as follows:

Facility Peer Group
LTC Accommodation Code
(Regular Services)
Behold Accommodation Code
Hospice Additional Reimbursement Per Diem
(95% of ICF/DD Supplemental Payment Per Diem)
ICF/DD
41 (1-59 beds)
43
$14.70
ICF/DD
41 (60+ beds)
43
$0.00
ICF/DD-H
61 (4-6 beds)
63
$10.21
ICF/DD-H
65 (7-15 beds)
68
$0.00
ICF/DD-N
62 (4-6 beds)
64
$11.85
ICF/DD-N
66 (7-15 beds)
69
$21.19
·         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 additional reimbursement.    

2018-19 ICF/DD Prop 56 Supplemental Payment News

On August 7, 2018, the Department of Health Care Services (DHCS) received approval from the Center for Medicare & Medicaid Services to extend 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, 2018, through July 31, 2019. Providers will continue to 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 Supplemental 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). 
 
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:
 
The deadline to submit completed surveys has been extended to December 14, 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 Supplemental 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: 12/13/2018 8:37 AM