Nursing Facility Financing Reform (AB 186)
Return to Freestanding Skilled Nursing Facilities and Subacute Units home
Assembly Bill 186 (Chapter 46, Statutes of 2022) amended the Medi-Cal Long-Term Care Reimbursement Act to reform the financing methodology applicable to Freestanding Skilled Nursing Facilities Level-B and Adult Freestanding Subacute Facilities Level-B. The financing methodology authorized by AB 186 is effective January 1, 2023 through December 31, 2026. AB 186 authorizes the Department of Health Care Services (DHCS) to implement three major new programs: Workforce & Quality Incentive Program (WQIP), Workforce Standards Program, and Accountability Sanctions Program. DHCS is developing these programs in 2022 and 2023.
The reforms authorized by AB 186 are intended to:
- Better incentivize and hold facilities accountable for quality patient care.
- Emphasize the critical role of workforce.
- Better balance distribution of annual rate increases.
- Result in the long-term financial viability of facilities in the Medi-Cal managed care environment.
Program Components
Program Component
| Development Timeline
| Implementation Timeline
|
Workforce & Quality Incentive Program (WQIP). DHCS will provide directed payments to facilities to incentivize workforce and quality. This program succeeds the former Quality and Accountability Supplemental Payment (QASP) program.
| September 2022 - December 2022
| Payments made to facilities in early 2024 based on Calendar Year (CY) 2023 utilization.
|
Workforce Standards Program (WSP). DHCS will establish workforce standards such as maintain a collective bargaining agreement or paying prevailing wage. DHCS will provide facilities that meet these standards with a workforce augmentation to base their per diem rate effective for CY 2024. Please visit the WSP wepage for more information.
| Implemented October 1, 2024
| CY 2024 Rates published October 1, 2024 on the FS/NF-B and FSSA homepage.
|
Accountability Sanctions Program (ASP). DHCS is authorized to sanction facilities that do not meet quality standards established by DHCS on a per Medi-Cal bed day basis.
| July 2023 - November 2023
| Quality standards will be effective for CY 2024.
|
DHCS Public Notice for Proposed State Plan Amendment #24-0004
On December 28, 2023, DHCS released the proposed State Plan Amendment (SPA) #24-0004 for public input. SPA 24-0004 proposes to renew and modify the reimbursement methodology for Freestanding Skilled Nursing Facilities Level-B and Adult Freestanding Subacute Facilities Level-B and implement the Workforce Standards Program. Comments were due to DHCS on January 29, 2024.
SNF ASP Policy Letter
On December 12, 2024, DHCS published the
SNF ASP Policy Letter 24-002 to provide an overview for Measurement Year 2025.
DHCS will issue a more detailed policies and procedures on the SNF ASP Sanction appeals and waivers in a future Policy Letter.
For more information on the ASP, please visit the
SNF ASP webpage.
SNF WQIP
For information on the WQIP, please visit the SNF WQIP webpage.
Stakeholder Consultation
AB 186 requires DHCS to establish the methodology, parameters, and eligibility criteria for these programs in consultation with representatives from the long-term care industry, organized labor, consumer advocates, and managed care plans. DHCS is continuing to research and refine the program design and welcomes stakeholder input. Please submit any written comments to:
Nursing Facility Financing Reform Webinar
DHCS is hosting virtual stakeholder webinars to discuss the Workforce and Quality Incentive Program (WQIP), Workforce Standards Program, and Accountability Sanctions Program, authorized by
Assembly Bill 186 (Chapter 46, Statutes of 2022).
These webinars will also provide an opportunity for stakeholder input.
Next Meeting:
To be announced.
Meeting Tips:
How To Raise Hand During a Meeting
Past Meetings:
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October 25, 2022 Presentation Materials
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November 18, 2022 Presentation Materials
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December 21, 2022 Presentation Materials
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February 1, 2023 Presentation Materials
- March 10, 2023 Presentation Materials
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April 12, 2023 Presentation Materials
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June 8, 2023 Presentation Materials
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July 27, 2023 Presentation Materials
- October 13, 2023 Presentation Materials
- November 17, 2023 Presentation Materials
- December 15, 2023 Presentation Materials
- May 10, 2024 Presentation Materials
Accessibility:
For individuals with disabilities, DHCS will provide free assistive devices, including language and sign-language interpretation, real-time captioning, note takers, reading or writing assistance, and conversion of training or meeting materials into braille, large print, audio, or electronic format. To request alternative format or language services, please call or write:
Department of Health Care Services
Fee-For-Service Rates Development Division
1501 Capitol Avenue, MS 4600
P.O. Box 997417
Sacramento, CA 95899-7417
(916) 552-9600
Please note that the range of assistive services available may be limited if requests are received less than ten working days prior to the meeting or event.
AB 186 E-mail Distribution List
This e-mail service (ListServ) has been created so interested stakeholders can receive relevant updates on the AB 186 programs.
Additional Information:
Freestanding Skilled Nursing Facilities and Subacute Units
