Medi-Cal Update

Long Term Care | June 2019 | Bulletin 508

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1. Revised 2018 – 2019 Intermediate Care Facility Reimbursement Rates

The Department of Health Care Services (DHCS) is revising 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) effective August 1, 2018, to account for an additional increase to the minimum wage add-on.

The ICF/DD, ICF/DD-H and ICF/DDN rates are established according to State Plan Amendment (SPA) 16-012 and the Welfare and Institutions Code (W&I Code), Section 14105.075, which authorize DHCS 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 also includes 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 adjusting the previously established rate effective August 1, 2018, due to an additional increase in the minimum wage add-on. The revised rates, effective August 1, 2018, will continue to include the additional facility-specific add-on related to the Patient Protection and Affordable Care Act (ACA) Employer Shared Responsibility mandate, and the ACA 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.

Additionally, DHCS will continue providing the below supplemental per diem amounts for the respective peer groups as approved by the Centers for Medicare & Medicaid Services in SPA 18-0029, which extends the ICF/DD Proposition 56 supplemental payment through July 31, 2019.

Facility Peer Group Long Term Care Accommodation Code (Regular Service) Bedhold 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 billed for dates of service from 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 please 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. July 2019 Medi-Cal Provider Seminar

The July Medi-Cal Provider Seminar is scheduled for July 17 – 18, 2019, at the Sheraton Grande Hotel in Sacramento, 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 July 3, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After July 3, 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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3. National Correct Coding Initiative Quarterly Update for July 2019

The Centers for Medicare & Medicaid Services (CMS) are scheduled to routinely release the quarterly National Correct Coding Initiative (NCCI) in Medicaid payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and will be effective for dates of service on or after July 1, 2019.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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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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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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