Medi-Cal Update

Long Term Care | November 2018 | Bulletin 501

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1. 2018 – 2019 Intermediate Care Facility Reimbursement Rates Update

Effective for dates of service on or after August 1, 2018, the 2018 – 2019 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, 2018, 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.

DHCS is providing an additional supplemental payment, effective August 1, 2018. The Centers for Medicare & Medicaid Services approved SPA 18-0029 to extend the ICF/DD Proposition 56 supplemental payment and provide an additional time-limited per diem amount for the below peer groups, through July 31, 2019.

Facility Peer Group Long Term Care Accommodation Code (Regular Service) Bed Hold Accommodation Code Supplemental Payment Per Diem
ICF/DD (1 – 59 beds) 41 43 $15.47
ICF/DD (60+ beds) 41 43 $0
ICF/DD-H (4 – 6 beds) 61 63 $10.75
ICF/DD-H (7 – 15 beds) 65 68 $0
ICF/DD-N (4 – 6 beds) 62 64 $12.47
ICF/DD-N (7 – 15 beds) 66 69 $22.30

Note:

Facilities in peer groups in which the unfrozen 2017 – 2018 65th percentile rate is lower than the current reimbursement rate will not receive the supplemental payment.

The California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary (FI) will provide the supplemental payment per diem amounts to the respective peer groups, in addition to the regular reimbursement rates, for every claim that is billed for dates of services August 1, 2018, through July 31, 2019. 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; the CA-MMIS FI will process any retroactive rate adjustments for claims paid at the old rate. If you have any questions regarding claims and payments you may contact the Telephone Service Center 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. 2018 – 2019 Distinct Part Nursing Facilities – Level B Reimbursement Rate Update

Effective for dates of service on or after August 1, 2018, the California Department of Health Care Services (DHCS) has updated the 2018 – 2019 Medi-Cal reimbursement rates for Distinct Part Nursing Facilities Level B (DP/NF-B).

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; the California Medicaid Management Information System Fiscal Intermediary will process any retroactive rate adjustments for claims paid at the old rate.

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

DHCS will notify providers of their DP/NF-B facility specific rates in a letter. In the meantime, providers may find their rates posted on the Distinct Part Nursing Facilities, Level B (DP/NF-B) page on 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 (2)
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3. Rural Hospital Swing Bed Rates Updated for 2018

Effective for dates of service on or after August 1, 2018, the rural swing bed rates for accommodation codes 04 (regular services) and 05 (leave of absence [LOA]/bed hold [BH]) are updated.

Rural swing bed rates are exempt from the 10 percent payment reduction of Assembly Bill 97, but are subject to the AB 97 rate freeze at the reimbursement rate established in 2008 – 2009 including any applicable add-ons. However, retroactive to September 1, 2013, Distinct Part Nursing Facilities Level B (DP/NF-B) located in designated rural or frontier areas are exempt from the AB 97 rate freeze.

Effective August 1, 2018 the rural swing bed rates in hospitals located in designated rural/frontier areas with DP/NF-Bs are exempt from the AB 97 rate freeze.

Rural Swing Bed
(exempt from AB 97 rate freeze)
Accommodation Code Rate
04 $410.32 *
05 $402.40 **

* Includes 2018 $1.75 add-ons
** Includes 2018 LOA/BH rate of $7.92

Effective August 1, 2018, the rural swing bed rates for rural hospitals that do not have a DP/NF-B are not exempt from the AB 97 rate freeze.

Rural Swing Bed
(nonexempt from AB 97 rate freeze)
Accommodation Code Rate
04 $311.34 *
05 $303.42 **

* Includes 2008 rate of $305.15 plus 2018 $6.19 unfrozen add-ons
** Includes 2018 LOA/BH rate of $7.92

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

Rural swing bed rates are listed on the Rural Swing Bed page of the Department of Health Care Services (DHCS) website.

For billing or payment questions, providers should 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 (6)
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4. Updates to the Lists of Contracted Incontinence Products

Effective for dates of service on or after December 1, 2018, products from the following manufacturers are added to the List of Contracted Incontinence Absorbent Products: Attends Healthcare Products, Inc.; Bandz, Inc.; Essity HMS North American, Inc.; McKesson Medical-Surgical; Medline Industries, Inc.; Secure Personal Care; and Sigma Supply & Distribution, Inc.

Effective for dates of service on or after March 1, 2019, certain products from the following manufacturers are deleted from the List of Contracted Incontinence Absorbent Products and are no longer reimbursable: Attends Healthcare Products, Inc.; Essity HMS North American, Inc.; Secure Personal Care; and Smart Choice Medical.

Effective for dates of service on or after March 1, 2019, the List of Contracted Incontinence Creams and Washes is updated. Products from manufacturer Smart Choice Medical are deleted from the list and are no longer reimbursable.

The maximum acquisition cost (MAC) for products deleted from the lists is no longer guaranteed by the manufacturer.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Long Term Care
Pharmacy
incont (10)
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5. Sign Language Interpreter Services Code Conversion Reminder

The sign language interpreter services code conversion will replace HCPCS Level III local codes, commonly referred to as local codes, with HIPAA-compliant HCPCS Level II national codes. This billing requirement for sign language interpreter services is mandated by HIPAA and is effective for claims with dates of service on or after January 1, 2019.

For claims with dates of service on or after January 1, 2019, the sign language interpreter services code conversion will be replacing HCPCS Level III local codes Z0324 and Z0326 with HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes).

As of January 1, 2019, HCPCS Level III local codes Z0328 and Z0329 used to bill for sign language interpreter services will no longer be reimbursable.

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

Providers are encouraged to watch for sign language interpreter service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to sign language interpreter services.

For additional information, providers may:

Questions regarding the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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6. 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

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  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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