指定中级护理机构
The Designated Intermediate Care Facility (DICF) Quality Assurance Fee (QAF) program is governed by the California Health and Safety Code, Sections 1324 through 1324.14. These provisions require the California Department of Health Care Services (DHCS) to impose a QAF based on the gross receipts for each DICF, including Developmentally Disabled (DICF-DD), Developmentally Disabled Habilitative (DICF-DD-H), and Developmentally Disabled Nursing (DICF-DD-N). For the purposes of this program, the term “gross receipts” is defined as compensation for services provided to residents of a DICF, not including the following:
- 由于多付款而向付款人退还任何金额
- 坏账
- 该工厂收到的供应商回扣
- 该设施收到的慈善捐款
As a condition for a DICF to participate in the Medi-Cal program, payments to DHCS must be made on or before the last day of each calendar quarter, following the calendar quarter for which the fee is imposed. DHCS has the discretion to make retroactive adjustments as necessary to ensure that the fees collected do not exceed 6 percent. Please refer to the following link regarding important changes to DICF QAF requirements: DICF Bulletin 388
请注意，“日治疗费用支付”部分已从 QAF 季度付款发票中删除。 我们将通过邮件发送日间治疗费用支付的单独发票。
QAF-DICF 付款和报告表
在线提交表格 - 使用此链接以电子方式提交总收入数据：
Printable Forms – Use these links to print the form and mail gross receipts data, along with the corresponding QAF payment:
请确保输入您的机构名称、地址和国家提供者识别（NPI）号码，以便您的付款能够记入正确的账户。
Provider bulletins and rates information is available on the Long Term Care Reimbursement webpage.
DHCS 现在接受向 DICF 计划进行电子资金转账 (EFT)。 欲了解更多信息，请访问TPLRD EFT 支付网页。
注意：如果放错或没有发票号码，请参考下表，使用默认发票号码付款。
| 质量保证框架计划 | 发票号码 |
|---|---|
| 指定中级护理机构（DICF） | ICF12345678 |
| Day Treatment – DICF | DAY12345678 |
当使用上述默认发票号码通过电子资金转账 (EFT) 付款时，请发送电子邮件至QAF@dhcs.ca.gov并提供下列详细信息，以确保电子资金转账 (EFT) 付款正确过账和应用：
- 提供商名称
- 国家医疗服务提供者识别码 (NPI) 号码
- 如果您与其他机构共享 NPI，请提供您的供应商编号。
- 电子转帐付款金额
- 电子资金转账付款日期
- 付款发票和/或人口普查数据，标明 EFT 付款的用途（即季度和费率年度）。
有疑问吗？
如果对 QAF 付款有任何疑问，请联系：
Department of Health Care Services
Third Party Liability & Recovery Division
Quality Assurance Fee Program – MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
电话： (916) 650-0583
传真：（916）440-5671
电子邮件： QAF@dhcs.ca.gov