Medi-Cal Update

Long Term Care | March 2017 | Bulletin 481

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1. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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2. Update: DHCS Fiscal Intermediary Name Change

Effective immediately, providers may notice that the Department of Health Care Services (DHCS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly Xerox State Healthcare, LLC (Xerox), is operating under a new company name, “Conduent.” Providers may also see the Conduent logo on some items.

Operations and interactions with providers are not impacted by this FI name change.

Providers may see this name change in items such as:

  • NewsFlash articles and Medi-Cal Update bulletins
  • Medi-Cal website (www.medi-cal.ca.gov)
  • Forms and User Guides
  • Provider Manuals
  • Medi-Cal Learning Portal (MLP)
  • Presentations at Provider Training Seminars
  • Provider Letters, such as Erroneous Payment Corrections (EPCs)
  • Additional hard copy correspondence
  • Emails with an “@conduent.com” address rather than an “@xerox.com” address
  • References to the Conduent name when researching mailing addresses or published telephone numbers
Conduent logo

There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same.

Medi-Cal providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to Medi-Cal Update bulletins, NewsFlash articles, and System Status Alerts. Providers may sign up for MCSS by visiting http://www.medi-cal.ca.gov and completing the MCSS Subscriber Form. For more information about Conduent, visit https://www.conduent.com.

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3. Reimbursement Rates for DP/PSA and FS/PSA Increased

Effective retroactively for dates of service on or after August 1, 2016, reimbursement rates for Distinct Part Nursing Facilities (DP/PSA) and Freestanding Nursing Facilities (FS/PSA) of Pediatric Subacute services have increased.

The rates are posted on the Distinct Part Pediatric Subacute (DP/PSA) and Freestanding Pediatric Subacute (FS/PSA) Facilities Web page on the Department of Health Care Services (DHCS) website. Facilities should begin using these rates to bill for services. A letter containing rate updates will be or have been mailed to individual facilities.

Claims with effective dates of service on or after August 1, 2016, will automatically be adjusted for proper claims payment.

The 2016 – 2017 rates for DP/PSA were established based on a model developed from comparable peer group cost information, plus the cost of new state or federal mandates (add-ons). The calculated ventilator dependent rate is $1,071.04 and the non-ventilator rate is $983.09. The rates are as follows:

Accommodation Code 83 84 85 86 87 / 89 88 / 90
Rate $ 67.30 $ 62.74 $ 1,071.04 $ 983.09 $ 1,063.69 $ 975.74

The 2016 – 2017 rate year mandates for DP/PSA include
  Description Rate
  Minimum wage Assembly Bill 10 (2016) $ 0.35
  2017 minimum wage Senate Bill 3    0.10
  2016 – 2017 Federal Unemployment Tax Act (FUTA)    0.33
  2015 – 2016 FUTA    0.11
  Patient Protection and Affordable Care Act (ACA) reporting    0.54
  Paid sick leave    1.72
  Payroll-based journal    0.13

The 2016 – 2017 rates for FS/PSA continue frozen at their 2008 – 2009 rates plus the cost of new state and federal mandates). The mandates are not applied to rehabilitation therapy and ventilator weaning rates. The FS/PSA rates are as follows:

Accommodation Code 91 92 93 / 95 94 / 96 97 98
Rate $ 795.67 $ 727.04 $ 788.32 $ 719.69 $ 50.35 $ 46.94

The 2016 – 2017 rate year mandates for FS/PSA include those for DP/PSA plus
  Description Rate
  Quality assurance fee $ 15.95

Mandates for previous rate years are as follows:

2015 – 2016
  Description Rate
  Minimum wage AB 10 $ 0.06
  FUTA    0.11
  ACA reporting    0.54
  Paid sick leave    1.72

2014 – 2015
  Description Rate
  Transitional reinsurance and the Patient Centered Outcomes Research Institute (PCORI) fee $ 0.03
  FUTA    0.11

2013 – 2014 (carry over due to frozen rates)
  Description Rate
  Transitional reinsurance and PCORI fee $ 0.04
  ACA compliance program    0.66
  FUTA    0.11
  HIPPA electronic funds transfer and remittance advice    0.03

2012 – 2013 (carry over due to frozen rates)
  Description Rate
  Informed consent $ 0.19
  Standard admissions agreement    0.02
  Elder Justice Act    0.01
  FUTA    0.11

2011 – 2012 (carry over due to frozen rates)
  Description Rate
  Immunization/vaccine for airborne diseases $ 0.25
  Minimum data set    0.51

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (8, 9)
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4. Facility-Specific FS/NF-B Reimbursement Rates Established

Effective retroactively for dates of service on or after August 1, 2016, final facility-specific reimbursement rates for Free-Standing Nursing Facilities Level B (FS/NF-B) have been established.

Claims for dates of service on or after August 1, 2016, will be automatically reprocessed for proper claim reimbursement. The final rates are posted on the Long-Term Care Reimbursement AB 1629 page of the Department of Health Care Services (DHCS) website. Providers must use the new rates to bill for services.

Facility-specific reimbursement rates are computed annually. Rates are based upon the facility's 2014 audit data. Final rates are adjusted for new 2016 – 2017 mandates and capped to adhere to program budgeted amounts.

Mandates
The 2016 – 2017 mandates total $3.06. This includes the following:

There is also an add-on for the ACA employer mandate for applicable large employers. This amount is calculated on a facility-specific basis.

Change of Ownership
Changes of ownership or changes of licensed operator do not qualify for increases in reimbursement rates. For more information, refer to the AB 1629 Facility-Specific Rate Methodology Clarifications article on the DHCS website.

Leave of Absence/Bed Hold Reduction
The 2016 – 2017 reduction for a leave of absence or bed hold is $7.35.

Quality Assurance Fee
The approved FS/NF-B quality assurance fee (QAF) amount for facilities reporting fewer than 100,000 days is $15.95. For facilities reporting 100,000 days or more, the QAF amount is $14.85.

2016 – 2017 Peer Group Weighted Averages
Peer Group ID Includes QAF Excludes QAF
1 $ 180.18 $ 164.23
2    205.75    189.80
3    211.66    195.71
4    224.92    208.97
5    188.48    172.53
6    202.72    186.77
7    232.00    216.05
Statewide Weighted Average    204.64    188.69

Out-of-state or border providers will be reimbursed at the statewide weighted average of $188.69.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (2, 3)
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5. New Facility-Specific Reimbursement Rates Established for FSSA/NF-B

Effective retroactively for dates of service on or after August 1, 2016, new facility-specific reimbursement rates for Free-Standing Adult Subacute Skilled Nursing Facilities Level B (FSSA/NF-B) have been established.

The rates are posted on the Long-Term Care Reimbursement AB1629 Web page of the Department of Health Care Services (DHCS) website. Providers should use these rates to bill for dates of service on or after August 1, 2016. No additional action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

FSSA/NF-B facility-specific reimbursement rates are computed annually. The 2016 – 2017 rates are based on the audited costs for facility fiscal periods ending in 2014. The 2016 – 2017 rates were calculated and adjusted for new state and federal mandates.

The 2016 – 2017 rate year mandates total $3.06. The components include:

Description Rate
Minimum wage Assembly Bill 10 (2016) $ 0.35
2017 Minimum wage Senate Bill 3    0.10
2016 – 2017 Federal Unemployment Tax Act (FUTA)    0.11
2015 – 2016 FUTA    0.11
Patient Protection and Affordable Care Act Reporting    0.54
Paid sick leave    1.72
Payroll-based journal    0.13

The 2016 – 2017 rate reduction for leave of absence or bed hold is $7.35.

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6. Extended Deadline of the Streamlined Procedure for ACA-Related Appeals

The filing period for submission of Patient Protection and Affordable Care Act-related (ACA) appeals is extended from June 30, 2016, to December 31, 2017. The deadline has been extended to assist providers in completing all their ACA-related appeals.

The Streamlined Procedure for ACA-Related Appeals published February 23, 2016, details the submission of appeals regarding ACA payments for Medi-Cal services. Providers should closely follow the article's instructions in all regards except for the filing deadline.

Providers with questions may call the Telephone Service Center at 1-800-541-5555.

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7. Improving the Quality of Care: Risks Associated with Use of Fluoroquinolones

A new DUR Educational Article titled “Improving the Quality of Care: Risks Associated with Use of Fluoroquinolones” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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8. April 2017 Medi-Cal Provider Seminar

The next Medi-Cal seminar is scheduled for April 25 – 26, 2017, at the Long Beach Marriott in Long Beach, California. Providers can access a class schedule for the seminar by visiting the Provider Training Web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and Conduent, the Fiscal Intermediary for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by April 11, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 11, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page of the Medi-Cal website.

Note:  Wi-Fi will not be provided at the seminar, please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training Web page and refer to it often for current seminar information.

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9. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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