Intermediate Care Facilities 

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

These facilities are peer grouped by level of care and bed size and are reimbursed at the 2008-09 65th percentile established for the facility’s respective peer group increased by 3.7 percent, through the enabling legislation of Assembly Bill (AB) x21, and Welfare and Institutions Code Section 14105.075.  The reimbursement rate will also include the projected cost of complying with any new State or federal mandates to the extent applicable to the reimbursement methodology associated with the type of facility. 

Temporary COVID-19 Increased Rates

Correction to Previously Posted Temporary COVID-19 Increased Rates

The previously posted rates for the 2019-20 temporary COVID-19 increased rates for Developmentally Disabled (ICF/DD), Habilitative (ICF/DD-H), Nursing (ICF/DD-N) facilities included erroneous rates for some providers that resulted in underpayments for the period of March 1, 2020 through June 22, 2020 and overpayments for the period of June 23, 2020 through July 31, 2020.

As of August 19, 2020, corrected COVID-19 increased rates were installed in the payment system with a March 1, 2020 effective date. Retroactive payment adjustments will be made as necessary by the fiscal intermediary through an erroneous payment correction (EPC). The EPC to retroactively adjust the claims for the temporary COVID-19 increased rates will reflect the following adjustments:

The March 1, 2020 through June 22, 2020 Underpayment Period:  The EPC will adjust eligible claims paid at the regular 2019-20 rates up to the corrected temporary COVID-19 increased rates.

The June 23, 2020 through July 31, 2020 Overpayment Period:  The EPC will adjust overpaid claims to the corrected temporary COVID-19 rates. The negative adjustment will reduce any amount due to the provider for the underpayment outlined in item 1.

Retroactive payment adjustments will be made automatically by the fiscal intermediary, and no additional action will be necessary on the providers' part.

2019-20 Intermediate Care Facilities Rates

The 2019-20 reimbursement rates are effective August 1, 2019 to February 29, 2020.

2018-19 Intermediate Care Facilities Amended Rates

The Department amended the 2018-19 reimbursement rates effective for dates of service on or after August 1, 2018, due to revisions made to the Minimum Wage add-on. Providers will continue to receive the initial 2018-19 reimbursement rates until the 2018-19 amended reimbursement rates are implemented in the system. Once the amended reimbursement rates are implemented, the Department will issue payments retroactive to August 1, 2018.

The following is a comprehensive list of the 2018-19 Amended Rates including the supplemental payment per diem, and the total reimbursement rates for all ICFDDs peer groups. The 2018-19 amended rates include the 3.7 percent rate increase, applicable add-ons, and the Quality Assurance Fee (QAF). The respective peer group supplemental payment amount will be automatically added to the claim payment by our Fiscal Intermediary, Conduent State Healthcare, LLC, for every claim that is billed for dates of service August 1, 2018 through July 31, 2019.

The following amended rates are for all facilities by peer group and are the rates for the facilities that did not submit a certification form.

 

The following amended rates include the additional facility-specific add-on related to the ACA Employer Shared Responsibility Mandate and the ACA IRS Employer Reporting Mandate.  These amended rates are only for the facilities that submitted either or both the ACA Mandate forms.

2018-19 Intermediate Care Facilities Supplemental Payment Per Diem Amounts

 
Facility
Peer Group
ICF/DD Accommodation Codes
(Regular Services)
Bedhold Accommodation Codes
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.     
  

2018-19 Intermediate Care Facilities Rates

The Department updated the 2018-19 reimbursement rates effective for dates of service on or after August 1, 2018.

2018-19 Comprehensive Rate List

Below is a comprehensive LTC rate list of the 2018-19 Rate, Supplemental Per Diem, and the total LTC reimbursement rates. The 2018-19 Rate includes the 3.7 percent rate increase, applicable add-ons, and the Quality Assurance Fee. 

Providers should continue to bill the 2018-19 Rate in accordance with the Medi-Cal Provider Manual. The respective peer group supplemental payment amount will be automatically added to the claim payment by our Fiscal Intermediary, Conduent State Healthcare, LLC, for every claim that is billed for dates of service August 1, 2018 through July 31, 2019.

2018-19 Intermediate Care Facilities Rates

The Department updated the 2018-19 reimbursement rates effective for dates of service on or after August 1, 2018. 

The following rates are for all facilities by peer group and are the rates for the facilities that did not submit a certification form.         

The following rates include the additional facility-specific add-on related to the ACA Employer Shared Responsibility Mandate and the ACA IRS Employer Reporting Mandate.  These rates are only for the facilities that submitted either or both the ACA Mandate forms.   

 Previous Intermediate Care Facility Rates

 

Return to Long Term Care Reimbursement Home

Last modified date: 3/29/2021 10:41 AM