Medi-Cal Update

Long Term Care | December 2017 | Bulletin 490

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1. 2017 – 2018 Intermediate Care Facility Reimbursement Rates Update

Effective for dates of service on or after August 1, 2017, the 2017 – 2018 reimbursement rates for Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), ICF/DD-Habilitative (ICF/DD-H) and ICF/DD-Nursing (ICF/DD-N) have been updated.

Pursuant to State Plan Amendment (SPA) 16-012 and Welfare and Institutions Code (W&I Code), Section 14105.075, the Department of Health Care Services (DHCS) is authorized to reimburse facilities at the 2008 – 2009 65th percentile established for the facility's respective peer group, increased by 3.7 percent. 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.

DHCS is providing facility-specific reimbursement by way of an add-on to the Medi-Cal reimbursement rate for the additional cost of health care coverage solely due to Employer Shared Responsibility requirements in the Patient Protection and Affordable Care Act (ACA) embodied in Section 4980H of the Internal Revenue Code (IRC). Effective August 1, 2017, the rates will include the additional facility-specific add-on related to the ACA Employer Shared Responsibility mandate and the ACA Internal Revenue Service (IRS) Employer Reporting mandate, only for the facilities that submitted a certification form. Providers should note that individual rate letters will be mailed to the providers that submitted a certification form, since the add-ons are facility specific.

The DHCS Fiscal Intermediary (FI), Conduent, will process claims with the new rates for services provided on or after August 1, 2017. Providers may direct questions regarding claims and reimbursements to the Telephone Service Center (TSC) at 1-800-541-5555.

The new rates, ACA add-ons and other information related to ICF/DD, ICF/DD-H and ICF/DD-N are available on the Intermediate Care Facilities web page of the DHCS website.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (5)
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2. Long Term Care Facility Rate Change for Nursing Facilities – Level A

Effective for dates of service on or after August 1, 2017, reimbursement rates for Long Term Care Nursing Facilities – Level A (NF-A) are increased to include the following mandated add-ons:

NF-A Add-ons 2017 – 2018 Rate Year
MDS 3.0 $0.51
Vaccine $0.25
Std Adm Agreement $0.02
Elder Justice Act $0.01
ACA Reinsurance Fee & PCORI $0.04
HIPAA Electronic Fund Transfer (EFT) and RA $0.03
ACA Compliance Program $0.66
Minimum Wage (July 2014) $1.71
Minimum Wage (January 2016) $2.43
2012 – 13 Federal Unemployment Tax Act (FUTA) $0.05
2013 – 14 FUTA $0.05
2014 – 15 FUTA $0.05
2015 – 16 FUTA $0.05
2016 – 17 FUTA $0.05
2017 – 18 FUTA $0.05
ACA Reporting $0.43
Sick Leave (July 2015) $1.72
Minimum Wage (January 2017 Senate Bill 3) $0.17
Minimum Wage (January 2018 SB 3) $0.80
Standard of Participation $0.04
2017 – 18 Payroll-Based Journal $0.26
Total 2017 – 2018 Add-ons $9.38

Assembly Bill 97 added Section 14105.07 and 14105.192 of the Welfare and Institutions Code (W&I Code) authorizing the Department of Health Care Services (DHCS) to reduce Medi-Cal provider payments up to 10 percent, originally effective for dates of service on or after June 1, 2011. In addition, AB 97 requires that the Medi-Cal reimbursement rates for specified provider classes shall not exceed the reimbursement rates applicable to those provider classes in the 2008 – 2009 rate year, as described in subdivision (f) of Section 14105.191 of W&I Code.

Effective August 2, 2003, NF-A per diem rates for facilities with a licensed bed capacity of 99 or fewer stopped utilizing bed size to establish rates. NF-A rates are set solely by geographical location. NF-A per diem rates for facilities with a licensed bed capacity of 100 or more, that received a rate of $89.54, effective August 1, 2002, were required to continue to receive this rate until such time their prospective county rate reaches this level.

Providers should bill using the new rates for dates of service on or after August 1, 2017. Providers do not need to rebill to adjust their payments. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

The rates are posted on the Freestanding Nursing Facilities, Level A (NF-A) page of the DHCS website.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (1)
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3. 2017 – 2018 Facility-Specific Reimbursement Rates Established for FSSA/NF-B

Effective for dates of service on or after August 1, 2017, the 2017 – 2018 facility-specific reimbursement rates for Free-Standing Adult Subacute Skilled Nursing Facilities Level B (FSSA/NF-B) are established.

The rates are posted on the Long Term Care Reimbursement Assembly Bill 1629 page of the Department of Health Care Services website. Providers should use these final rates to bill for dates of service on or after August 1, 2017. An Erroneous Payment Correction will be implemented to reprocess affected claims. No additional action is required of providers.

FSSA/NF-B facility-specific reimbursement rates are computed annually. The 2017 – 2018 rates are based on the audited costs for facility fiscal periods ending in 2015. The 2017 – 2018 rates were calculated and adjusted for new state and federal mandates.

The 2017 – 2018 rate year mandates total $1.39. The components include the following:

Description Rate
2016 minimum wage (AB 10) $ 0.15
2016 – 2017 Federal Unemployment Tax Act (FUTA) (ends after 2018 unless frozen) 0.05
2017 minimum wage (Senate Bill 3) 0.17
2017 – 2018 FUTA (ends after 2018 unless frozen) 0.05
2018 minimum wage (SB 3) 0.80
Payroll-based journal 0.13
Standards of participation 0.04

Additionally, there is an add-on under the Patient Protection and Affordable Care Act employer mandate for applicable large employers. This add-on amount is calculated on a facility-specific basis.

The 2017 – 2018 rate reduction for leave of absence or bed hold is $7.65.

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4. 2017 – 2018 Facility-Specific Reimbursement Rates Established for FS/NF-B

Effective for dates of service on or after August 1, 2017, the final 2017 – 2018 facility-specific reimbursement rates for Free-Standing Nursing Facilities Level B (FS/NF-B) are established.

The final rates are posted on the Long Term Care Reimbursement Assembly Bill 1629 page of the Department of Health Care Services (DHCS) website. Providers should use these final rates to bill for dates of service on or after August 1, 2017. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No additional action is required of providers.

FS/NF-B facility-specific reimbursement rates are computed annually. The 2017 – 2018 rates are based upon the facility's 2015 audit data. The final rates are adjusted for new 2017 – 2018 mandates and capped to adhere to program budgeted amounts.

Mandates
The 2017 – 2018 rate year mandates total $1.39. The components include the following:

Description Rate
2016 minimum wage (AB 10) $ 0.15
2016 – 2017 Federal Unemployment Tax Act (FUTA) (ends after 2018 unless frozen) 0.05
2017 minimum wage (Senate Bill 3) 0.17
2017 – 2018 FUTA (ends after 2018 unless frozen) 0.05
2018 minimum wage (SB 3) 0.80
Payroll-based journal 0.13
Standards of participation 0.04

Additionally, there is an add-on under the Patient Protection and Affordable Care Act (ACA) employer mandate for applicable large employers. This add-on 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 2017 – 2018 rate reduction for leave of absence or bed hold is $7.65.

Quality Assurance Fee (QAF)
The approved FS/NF-B QAF amount for facilities reporting fewer than 100,000 days is $15.38. For facilities reporting 100,000 days or more, the QAF amount is $14.28.

2017 – 2018 Rate Year Peer Group Weighted Averages
Peer Group ID Includes QAF Excludes QAF
1 $182.83 $167.45
2 $210.84 $195.46
3 $216.23 $200.85
4 $234.76 $219.38
5 $192.48 $177.10
6 $206.64 $191.26
7 $236.24 $220.86
Statewide Weighted Average $208.65 $193.27

Out-of-state or border providers will be reimbursed at the statewide weighted average of $193.27.

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. 2017 – 2018 Distinct-Part Nursing Facilities Reimbursement Rates Established

Effective for dates of service on or after August 1, 2017, reimbursement rates for Distinct-Part Nursing Facilities – Level B (DP/NF-B) have been established.

The rates are posted on the Distinct Part Nursing Facilities, Level B (DP/NF-B) 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, 2017. No additional action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. A letter containing rate updates will be or has been mailed to individual facilities.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (2)
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6. Distinct-Part Adult Subacute Reimbursement Rates Updated

Effective for dates of service on or after August 1, 2017, reimbursement rates for Distinct-Part Adult Subacute (DP/ASA) facilities are updated.

Providers need not rebill; retroactive rate adjustments will be processed for claims paid at the old rate for services provided on or after August 1, 2017.

Providers will be notified of the specific rates for DP/ASA facilities in a forthcoming letter. In the meantime, providers may locate their rates on the Subacute Care Facilities page of the Department of Health Care Services website.

For billing or payment questions, providers may call the Telephone Service Center at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (7)
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7. Update: Online PDF RAD and Medi-Cal Financial Summary

In early 2018 providers will be able to securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary. The PDF RADs will be available on the Medi-Cal website under the Transactions tab.

Note:

To access the transaction, providers must have a signed Medi-Cal Point of Service (POS) Network/Internet Agreement form on file, an NPI and PIN.

Benefits of PDF RAD
There will be many benefits to accessing RAD and Medi-Cal Financial Summary information online:

No provider payments will be made via PDF RADS. They will be informational only.

Providers should refer to future Medi-Cal Update bulletins for PDF RAD updates.

835 Transactions
Providers also are encouraged to sign up for the ASC X12N 835 transaction using the Electronic Health Care Claim Payment/Advice Receiver Agreement form (DHCS 6246). The form is located on the Forms page of the Medi-Cal website. The Medi-Cal website contains 835 transactions generated for the last six weeks. For information about 835 transactions, providers may refer to “ASC X12N 835 Transaction” in the Part 1 Medi-Cal provider manual section, Remittance Advice Details (RAD): Electronic.

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8. VeriFone VX 520 POS Device to Decommission in July 2018

In July 2018, the VeriFone VX 520 Point of Service (POS) device will be decommissioned. Providers may contact the POS Help Desk at 1-800-541-5555 (option 5, followed by option 6) for information about the decommission and for options.

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9. 2018 Medi-Cal Provider Training Schedule

The 2018 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 2 – 31 Webinar Information posted on the Medi-Cal website
February 13 – 14 Seminar Ontario
Ontario Airport Hotel & Conference Center
700 North Haven Ave.
Ontario, CA  91764
March 13 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
April 18 – 19 Seminar Escondido
California Center For The Arts
340 N. Escondido Blvd.
Escondido, CA  92025
May 15 – 16 Seminar Fresno
Double Tree Hilton
2233 Ventura Street
Fresno, CA  93721
June 5 – 28 Webinar Information to be posted on the Medi-Cal website
July 17 – 18 Seminar Alhambra
Almansor Court
700 S. Almansor Court St.
Alhambra, CA  91801
August 14 – 15 Seminar Sacramento
Sacramento Marriott
11211 Point East Drive
Rancho Cordova, CA  95742
September 18 – 19 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
October 16 – 17 Seminar Concord
Crown Plaza
45 John Glen Drive
Concord, CA  94520
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10. January 2018 Medi-Cal Provider Training Webinars

Beginning January 2, 2018, and continuing throughout the month of January, Medi-Cal providers may participate in provider training webinars:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education web page of the Medi-Cal website.

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

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For more information about MCSS, please visit the MCSS Help page.

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12. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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