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Supplemental Payment Program Implemented for ICF-DD Services

April 10, 2018

On March 26, 2018, the Department of Health Care Services (DHCS) implemented the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56), a supplemental payment program for Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), Intermediate Care Facilities for the Developmentally Disabled/Habilitative (ICF/DD-H) and Intermediate Care Facilities for the Developmentally Disabled/Nursing (ICF/DD-N). The supplemental payment program is effective for dates of service from August 1, 2017, through July 31, 2018.

A single reimbursement payment includes the current per diem rate in addition to the supplemental payment amount shown below. The supplemental payment amount is automatically added to reimbursements for claims meeting the supplemental payment criteria.

ICF/DD Supplemental Payment Plan
Facility Type LTC Accommodation Code Bed Hold Accommodation Code Supplemental Payment Per Diem
ICF/DD

41 (1 – 59 beds) 43 $15.47
ICF/DD 41 (60+ beds) 43 $0.00
ICF/DD-H 61 (4 – 6 beds) 63 $10.75
ICF/DD-H 65 (7 – 15 beds) 68 $0.00

ICF/DD-N 62 (4 – 6 beds) 64 $12.47
ICF/DD-N 66 (7 – 15 beds) 69 $22.30

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

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.