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Correction: Updated LTC Rates for Pediatric Subacute Facilities

June 3, 2016

The following article published in the May 2016 Medi-Cal Update with Long Term Care (LTC) rates for accommodation codes 87 and 89 incorrectly listed as $1,042.02. The corrected rate of $1,042.04 is applied to codes 87 and 89 in the article below. This correct rate was published in the Rates: Facility Per Diem section of the Part 2 provider manual.

Effective retroactively for dates of service on or after August 1, 2015, LTC rates for accommodation codes 83 – 98 are updated for Distinct-Part Pediatric Subacute (DP/PSA) and Free-Standing Pediatric Subacute (FS/PSA) facilities.

Final DP/PSA Reimbursement Rates
Rate updates for DP/PSA were developed from comparable peer group cost information, plus the cost of new state or federal mandates (add-ons). The calculated ventilator dependent rate is $1,049.12 and the non-ventilator rate is $963.54.

Effective August 1, 2015, the DP/PSA rates for Hospital Based Distinct-Part/Nursing Facility Level B (DP/NF-B) facilities are updated as follows:

Accommodation Code Description Rate
85 Hospital DP/NF-B – Ventilator Dependent; Regular Service $ 1,049.12
86 Hospital DP/NF-B – Non-ventilator Dependent; Regular Service $    963.54
87 Hospital DP/NF-B – Ventilator Dependent; Bed Hold $ 1,042.04
88 Hospital DP/NF-B – Non-ventilator Dependent; Bed Hold $    956.46
89 Hospital DP/NF-B – Ventilator Dependent; Leave of Absence $ 1,042.04
90 Hospital DP/NF-B – Non-ventilator Dependent; Leave of Absence $    956.46

Note:

A system issue was identified following installation of the ventilator dependent rate. The ventilator dependent rate exceeds the rate field limit of $1,000.00. Until this issue is resolved, claims processing for accommodation codes 85, 87 and 89 will be remitted at $990.00. The Department of Health Care Services (DHCS) will reimburse the difference as an additional, separate payment.

Final FS/PSA Reimbursement Rates
The 2015 – 2016 FS/PSA rates are unchanged from 2008 – 2016, but include increases due to the cost of new state and federal mandates (add-ons). The add-ons are not applied to rehabilitation therapy and ventilator weaning rates.

Effective August 1, 2015, the FS/PSA rates for Free-Standing NF-B facilities are updated as follows:

Accommodation Code Description Rate
91 Free-standing NF-B – Ventilator Dependent; Regular Service $ 796.00
92 Free-standing NF-B – Non-ventilator Dependent; Regular Service $ 727.37
93 Free-standing NF-B – Ventilator Dependent; Bed Hold $ 788.92
94 Free-standing NF-B – Non-ventilator Dependent; Bed Hold $ 720.29
95 Free-standing NF-B – Ventilator Dependent; Leave of Absence $ 788.92
96 Free-standing NF-B – Non-ventilator Dependent; Leave of Absence $ 720.29

Affected claims will be reprocessed via an Erroneous Payment Correction (EPC). No action is required of providers.

The 2015 – 2016 DP/PSA and FS/PSA rates are available in the Rates: Facility Per Diem section of the Part 2 provider manual and on the Pediatric Subacute Facilities page of the DHCS website.