Medi-Cal Update

Long Term Care | April 2018 | Bulletin 494

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1. IMD Reimbursement Rates Freeze

Effective retroactively for dates of service on or after July 1, 2017, Institutions for Mental Diseases (IMDs) rates are frozen at 2016/2017 levels pursuant to Senate Bill 90 (Committee on Budget and Fiscal Review, Chapter 25, Statutes of 2017). Freestanding Skilled Nursing Facilities Level-B (FS/NF-Bs) that are designated as IMDs will not receive the annual 3.5 percent rate increase until full funding is restored from vehicle license fee growth funds from the General Growth Subaccount in the Vehicle License Fee Growth Account.

These IMD facilities are exempt from the Assembly Bill 1629 (Frommer Chapter 875, Statues of 2004) facility-specific rate methodology and the Quality Assurance Fee program. Under SB 90, rates for IMDs will be frozen until full funding from vehicle license fee growth funds from the General Growth Subaccount in the Vehicle License Fee Growth Account become available for the Mental Health Subaccount of the Local Revenue Fund.

For more information, see AB 360 (Frommer, Chapter 508, Statutes of 2005), and AB 1054 (Chesbro, Chapter 303, Statutes of 2013) in the Rates: Facilities section of the appropriate Part 2 manual.

TOTAL BEDS 1 – 59 TOTAL BEDS 60 +
Accom. Code S.F.*
Bay Area Counties
Los Angeles County All Other Counties   S.F.*
Bay Area Counties
Los Angeles County All Other Counties
01 $ 213.36 $ 172.29 $ 185.38 $ 224.25 $ 172.52 $ 192.48
02 206.01 164.94 178.03 216.90 165.17 185.13
03 206.01 164.94 178.03 216.90 165.17 185.13
11 219.08 178.01 191.10 229.97 178.24 198.20
12 211.73 170.66 183.75 222.62 170.89 190.85

*  San Francisco Bay Area counties include Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara and Sonoma

Note 1:

The rates shown above for Accommodation Codes 11 and 12 include the Special Treatment Program (STP) supplement of $5.72 per resident, per day.

Note 2:

The rate reduction for IMD leave of absence and bed hold for acute hospitalization is $7.35 per diem for dates of service on or after July 1, 2017.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (4)
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2. Reimbursement Rates for DP/PSA and FS/PSA Updated

Effective retroactively for dates of service on or after August 1, 2017, the reimbursement rates for Distinct-Part Pediatric Subacute (DP/PSA) and Free-Standing Pediatric Subacute (FS/PSA) Nursing Facilities have updated.

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

Facilities do not need to rebill to adjust their payments. Claims with effective dates of service on or after August 1, 2017, will automatically be adjusted for proper claims payment.

The 2017 – 2018 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 $1,093.24 and the non-ventilator rate is $1,002.68. The DP/PSA rates are as follows:

Accommodation Code 83 84 85 86 87/89 88/90
Rate $ 68.41 $ 63.77 $ 1,093.24 $ 1,002.68 $ 1,085.59 $ 995.03

The 2017 – 2018 rate year add-ons for DP/PSA include:

  Description Rate
 2016 – 2017 Federal Unemployment Tax Act (FUTA) $ 0.05
 2017 – 2018 FUTA 0.05
 Minimum wage (Assembly Bill 10 2016 prorated for five of 12 months) 0.15
 Minimum wage (Senate Bill 3 2017) 0.17
 Minimum wage (SB 3 2018) 0.80
 2016 – 2017 Payroll-based journal 0.13
 Standards of Participation 0.04

The 2017 – 2018 rates for FS/PSA continue to be frozen at their 2008 – 2009 rates, plus the cost of new state or federal mandates. The add-ons 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 $ 795.76 $ 727.13 $ 788.11 $ 719.48 $ 50.35 $ 46.94

The 2017 – 2018 rate year add-ons for FS/PSA include:

  Description Rate
 2017 – 2018 Quality assurance fee (QAF) $ 15.38
  2017 – 2018 FUTA 0.05
 Minimum wage (SB 3 2018) 0.80
 Standards of Participation 0.04

Mandates for previous rate years are as follows:

2016 – 2017

  Description Rate
  2016 – 2017 FUTA $ 0.05
 Minimum wage (AB 10) 0.35
 Minimum wage (SB 3 2017) 0.17
 2016 – 2017 Payroll-based journal 0.13

2015 – 2016

  Description Rate
  2015 – 2016 FUTA $ 0.05
 Minimum wage (AB 10 2014) 0.06
 Patient Protection and Affordable Care Act (ACA) reporting 0.54
 Paid sick leave 1.72

2014 – 2015

  Description Rate
  2014 – 2015 FUTA $ 0.05
 Transitional reinsurance and the Patient Centered outcomes Research Institute (PCORI) fee 0.03

2013 – 2014 (carry over, due to frozen rates)

  Description Rate
  2013 – 2014 FUTA $ 0.05
 Transitional reinsurance and PCORI fee 0.04
 ACA compliance program 0.66
 HIPPA electronic funds transfer and remittance advice 0.03

2012 – 2013 (carry over, due to frozen rates)

  Description Rate
  2012 – 2013 FUTA $ 0.05
 Informed consent 0.19
 Standard admissions agreement 0.02
 Elder Justice Act 0.01

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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3. Adjustment to ICF/DD, ICF/DD-H and ICF/DD-N Reimbursement Rates

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 adjusted due to an update to the Patient Protection and Affordable Care Act (ACA) Employer Shared Responsibility mandate. The add-on amount for facilities that submitted a certification form and incurred additional costs due to the mandate has been adjusted. This adjustment only applies to facilities that submitted a certification form. Individual letters with updated rates will be mailed to providers that submitted a certification form since the add-ons are facility specific.

Providers should bill using the new rates for dates of service on or after August 1, 2017. No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. If providers have any questions regarding claims and payment, they may contact the Telephone Service Center at 1-800-541-5555.

For more information about the new rates, ACA add-ons and other information related to ICF/DD, ICF/DD-H and ICF/DD-Ns, providers may refer to the Intermediate Care Facilities page of the DHCS website.

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4. Manual Updates: Online PDF RAD and Medi-Cal Financial Summary

General information about the new PDF RAD has been added to the Medi-Cal provider manual.

Providers can securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary from the Transactions tab of the Medi-Cal website home page.

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.

PDF RAD User Guide Reminder
The PDF RAD Web Portal User Guide is available on the Medi-Cal website. The user guide contains step-by-step instructions to help providers view and download the PDF version of their RAD. Providers may download the guide from the User Guides page of the Medi-Cal website.

 

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

No provider payments are made via PDF RADs. They are informational only.

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.

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

Provider Manual(s) Page(s) Updated
Part 1 remit (1); remit and (3); remit elect (4)
Acupuncture
Adult Day Health Care Centers
AIDS Waiver Program
Audiology and Hearing Aids
Chiropractic
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Inpatient Services
Local Educational Agency
Long Term Care
Medical Transportation
Multipurpose Senior Services Program
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
remit adv (1)
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5. National Correct Coding Initiative Quarterly Update for April 2018

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after April 1, 2018.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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6. May 2018 Medi-Cal Provider Seminar

The May Medi-Cal provider seminar is scheduled for May 15 – 16, 2018, at the Double Tree Hilton in Fresno, 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 the DHCS Fiscal Intermediary (FI) 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 May 1, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After May 1, 2018, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 web 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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