Medi-Cal Update

Long Term Care | February 2019 | Bulletin 504

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1. Implementation Delay: Facility-Specific Reimbursement Rates for FSSA/NF-B

A previous article that published in the December 2018 Medi-Cal Update titled “2018 – 2019 Facility-Specific Reimbursement Rates Established for FSSA/NF-B,” informed providers that the Department of Health Care Services (DHCS) has established the final 2018 – 2019 facility-specific reimbursement rates for Free-Standing Adult Subacute Skilled Nursing Facilities Level B (FSSA/NF-B) services. This policy did not implement as previously scheduled but should implement in February 2019.

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

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2. Implementation Delay: Facility-Specific Reimbursement Rates for FS/NF-B

A previous article that published in the December 2018 Medi-Cal Update titled “2018 – 2019 Facility-Specific Reimbursement Rates Established for FS/NF-B,” informed providers that the Department of Health Care Services (DHCS) has established the final 2018 – 2019 facility-specific reimbursement rates for Free-Standing Nursing Facilities Level B (FS/NF-B) services. This policy did not implement as previously scheduled but should implement in February 2019.

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

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3. Corrected 2018 – 2019 Facility-Specific Reimbursement Rates for FS/NF-B

An article published in the December 2018 Medi-Cal Update titled 2018 – 2019 Facility-Specific Reimbursement Rates Established for FS/NF-B informed providers that effective for dates of service on or after August 1, 2018, the final 2018 – 2019 facility-specific reimbursement rates for Free-Standing Nursing Facility Level B (FS/NF-B) services are established. The rates are corrected below.

The final rates are posted on the Long-Term Care Reimbursement AB 1629 page of the Department of Health Care Services (DHCS) website. Providers should use these final rates to bill for dates of service on or after August 1, 2018. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No additional action is required of providers.

FS/NF-B facility-specific reimbursement rates are computed annually. The 2018 – 2019 rates are based upon the facility's 2016 audited cost report data. The final rates are adjusted for new 2018 – 2019 mandates and capped to adhere to program-budgeted amounts.

Mandates
The 2018 – 2019 rate year mandates total $3.13. The components include the following:

Description Rate
2017 minimum wage (Senate Bill 3) $0.07
2018 minimum wage (SB 3) 1.36
2019 minimum wage (SB 3) 0.32
LGBT Training (SB 219) 0.06
Standards of Participation 1.32

Additionally, there is an add-on for the staffing standard mandate (SB 97) that is calculated on a facility-specific basis.

Change of Ownership
Changes of ownership or changes of licensed operator do not qualify for increases in reimbursement rates. For more information, providers should refer to the AB 1629 Facility-Specific Rate Methodology Clarifications article on the DHCS website.

Leave of Absence/Bed Hold Reduction
The 2018 – 2019 rate reduction for leave of absence or bed hold is $7.92.

Quality Assurance Fee (QAF)
The approved FS/NF-B QAF amount for facilities reporting fewer than 100,000 days is $15.72. For facilities reporting 100,000 days or more, the amount is $14.46.

2018 – 2019 Rate Year Peer Group Weighted Averages
Peer Group ID Includes QAF Excludes QAF
1 $192.90 $177.18
2 224.06 208.34
3 227.78 212.06
4 245.84 230.12
5 204.55 188.83
6 216.10 200.38
7 246.23 230.51
Statewide Weighted Average 219.57 203.85

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (2, 3)
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4. Sign Language Interpreter Services Code Conversion Notice of Implementation

The Sign Language Interpreter Services code conversion, initially announced in the October 2018 Medi-Cal Update and NewsFlash area of the Medi-Cal website, implemented on January 1, 2019.

As of January 1, 2019, the sign language interpreter services code conversion requires providers to bill HIPAA-compliant HCPCS Level II national codes in place of non-HIPAA compliant HCPCS Level III local codes.

Effective January 1, 2019, the sign language interpreter services code conversion replaced HCPCS Level III local codes Z0324 and Z0326 with HCPCS Level II national code T1013. Previously billed non-HIPAA-compliant Level III local codes Z0328 and Z0329 were terminated and are no longer reimbursable.

The following resources for the sign language interpreter services code conversion are located on the HIPAA: Code Conversions page under the Miscellaneous Services dropdown:

For additional information, providers are encouraged to:

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

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5. Free-Standing Pediatric Subacute Facility Time-Limited Supplemental Payments

Effective for dates of service from August 1, 2018, through July 31, 2019, Free-Standing Pediatric Subacute (FS/PSA) facilities are scheduled to receive a time-limited supplemental payment in the amount of $132.92 for accommodation codes 91, 92, 93, 94, 95 and 96. This supplemental payment is in addition to the base per diem reimbursement rates for every claim that is billed for dates of service from August 1, 2018, through July 31, 2019.

The Centers for Medicare & Medicaid Services (CMS) approved the time-limited Supplemental Payment Program for FS/PSA facilities effective August 1, 2018, pursuant to State Plan Amendment 18-0042. This supplemental payment 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 Department of Health Care Services (DHCS) health care expenditures during the 2018 – 2019 state fiscal year.

Supplemental payments are expected to be implemented in February 2019. No action is required on the part of providers. An Erroneous Payment Correction (EPC) will be initiated in February 2019 to address retroactive payments for dates of service beginning on August 1, 2018.

For questions regarding claims and payments, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555.

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6. March 2019 Medi-Cal Provider Seminar

The next Medi-Cal Provider Seminar is scheduled for March 13 – 14, 2019, at the Ontario Airport Hotel & Conference Center in Ontario, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by February 27, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After February 27, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative web page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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