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Delayed Reimbursement Rate Increase for Home Health and PDHC Services

December 5, 2018

The Department of Health Care Services (DHCS) received federal approval to end-date the 1 percent payment reduction applied to home health services, and to increase reimbursement rates by 50 percent for home health and certain Pediatric Day Health Care (PDHC) services, effective July 1, 2018, pursuant to State Plan Amendment 18-0037. DHCS implemented the end-date of the 1 percent payment reduction for home health services on August 31, 2018, retroactive to July 1, 2018.

This rate increase was authorized by Senate Bill 856 (Chapter 30, Statutes of 2018), which appropriated the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds to be used as the nonfederal share for specified DHCS health care expenditures during the 2018 – 2019 state fiscal year.

The Medi-Cal reimbursement rates in effect on June 30, 2018, for home health and certain PDHC services will increase by 50 percent and the new Medi-Cal reimbursement rates effective July 1, 2018, are shown in the table below. The implementation of the rate increase is delayed and is expected to occur in early 2019, retroactive to July 1, 2018. Subsequent to implementation of the rate increase, DHCS will process an Erroneous Payment Correction (EPC) for any claims paid at the lower rate that may qualify for a payment adjustment based on the rate increase.

Providers should continue to bill their usual and customary charges, and DHCS will reimburse the provider the billed amount or the Medi-Cal fee schedule rate, whichever is lower. As a reminder, providers are able to adjust previously submitted claims as outlined in the CIF Completion (cif co) section of the appropriate Part 2 provider manual to correct their usual and customary charges back to the effective date of the rate increase, if necessary.

Procedure Code Medi-Cal Rate Effective July 1, 2018
Z5804 $47.91
Z5805 $52.70
Z5806 $36.63
Z5807 $40.29
Z5832 $60.86
Z5833 $66.95
Procedure Code Medi-Cal Rate Effective July 1, 2018
Z5834 $44.12
Z5835 $48.53
Z5836 $68.15
Z5838 $28.35
Z5840 $53.66
Z5868 $44.12