Medi-Cal Update

Long Term Care | October 2018 | Bulletin 500

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1. Long Term Care Facility Rate Change for Nursing Facilities – Level A

Effective for dates of service on or after August 1, 2018, 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 2018 – 2019 Rate Year
MDS 3.0 $0.51
Vaccine $0.25
Standard administration 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
ACA Reporting $0.43
Sick Leave (July 2015) $1.72
Minimum Wage (January 2017 Senate Bill 3) $0.17
Minimum Wage (January 2018 Senate Bill 3) $1.36
Minimum Wage (January 2019 Senate Bill 3) $0.32
Standard Participation $0.01
Infection Control $1.31
LGBT $0.04
2017 – 2018 Payroll-Based Journal $0.13
Total 2018 – 2019 Add-ons $11.15

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 W&I Code Section 14105.191(f).

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, 2018. 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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2. Distinct-Part Adult Subacute Reimbursement Rates Updated

Effective for dates of service on or after August 1, 2018, 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 rates for services provided on or after August 1, 2018.

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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3. HIPAA Notice of Code Conversion for Sign Language Interpreter Services

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324 and Z0326 for sign language interpreter services will be replaced with HIPAA-compliant national HCPCS Level II code T1013. HCPCS Level III local codes Z0328 and Z0329 will be terminated.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility required by law to provide sign language interpreter services.

The Sign Language Interpreter Services Code Conversion Crosswalk and additional information for this project will publish as details are determined.

Providers are encouraged to routinely check the Medi-Cal Update bulletin or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles, and/or System Status Alerts.

For additional information, providers may:

All other questions for the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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4. Sign Language Interpreter Code Conversion Billing Instructions

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324, Z0326, Z0328 and Z0329 for sign language interpreter services will be discontinued. Codes Z0324 and Z0326 will be replaced by national HIPAA-compliant HCPCS Level II code T1013. HCPCS Level II national code T1013 will be required to bill sign language interpreter services. Providers submitting UB-04 claim forms or ANSI 837I transactions must bill revenue codes in addition to national procedure codes. The Sign Language Interpreter Services Code Conversion Crosswalk is available for reference.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility that is required by law to provide sign language interpreter services.

Updated manual pages will be released in a future Medi-Cal Update.

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5. Sign Language Interpreter Services Code Conversion: Frequently Asked Questions

Effective for dates of service on or after January 1, 2019, the sign language interpreter services code conversion replaces HCPCS Level III local codes with HIPAA-compliant HCPCS Level II national billing codes. Providers are encouraged to familiarize themselves with the Sign Language Interpreter Services Code Conversion: Frequently Asked Questions.

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6. Alert: Mandatory Use of CURES 2.0 Begins October 2, 2018

A new DUR Educational Article titled “Alert: Mandatory Use of CURES 2.0 Begins October 2, 2018” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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7. National Correct Coding Initiative Quarterly Update for October 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 October 1, 2018.

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

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

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

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

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9. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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