Medi-Cal Update

Long Term Care | January 2020 | Bulletin 515

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1. New Medi-Cal Provider Website Nearing Completion

The Department of Health Care Services (DHCS) is nearing completion of the new Medi-Cal Provider website. DHCS anticipates this new website to be available to providers beginning in the spring of 2020.

This new Medi-Cal Provider website will contain content from the current Medi-Cal website but will offer the following additional features:

Access to Outreach and Education, including provider training, and Transaction Services will continue to be available from the Providers tab located within the navigation bar of the home page of the new website.

DHCS will publish additional updates about the new Medi-Cal Provider website in the coming months leading up to the spring of 2020. Providers are encouraged to regularly check the current Medi-Cal website as well as subscribe to the Medi-Cal Subscription Service (MCSS) to ensure they receive the latest policy and program updates.

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2. 2020 HCPCS Annual Update

The 2020 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the 2020 HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2020. Please refer to the 2020 HCPCS code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
chemo drug e-o (9); chemo drug p-z (7–9); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); surg eye (12); vaccine (4)
Obstetrics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); vaccine (4)
Pharmacy dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mc sup (2); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); presum bill (12); tax (9, 10)
Durable Medical Equipment dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); mc sup (2); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Orthotics and Prosthetics dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Therapies dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3)
Rehabilitation Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); vaccine (4)
Chronic Dialysis Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); vaccine (4)
Psychological Services psychol (4, 9); psychol cd (3)
Audiology tax (9, 10)
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3. 2019 – 20 Free-Standing Pediatric Subacute (FS/PSA) Rates Update

Effective for dates of service on or after August 1, 2019, the 2019 – 20 reimbursement rates for Free-Standing Pediatric Subacute (FS/PSA) facilities are updated.

Facilities should begin using these rates to bill for services. Facilities do not need to rebill to adjust reimbursements. The California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) will adjust all claims with dates of service on or after August 1, 2019. FS/PSA facilities will be notified of the rate update via letter.

The new rates and other information related to FS/PSA are available on the Distinct Part Pediatric Subacute (DP/PAS) and Freestanding Pediatric Subacute (FS/PSA) Facilities web page of the Department of Health Care Services (DHCS) website.

Final Reimbursement Rates
The 2019 – 20 FS/PSA rates continue to be frozen at their 2008 – 09 rates, plus the cost of new state and federal mandates (add-ons). The add-ons are not applied to rehabilitation therapy and ventilator weaning rates.

FS/PSA 2019 20 Frozen Rates

91 92 93/95 94/96 97 98
$801.09 $732.46 $792.74 $724.11 $50.35 $46.94


2019 – 20 Add-Ons:

2018 – 19 Add-Ons:

2017 – 18 Add-Ons:

2016 – 17 Add-Ons:

2015 – 16 Add-Ons:

2014 – 15 Add-Ons:

2013 – 14 Add-On Carry Over:

2012 – 13 Add-On Carry Over:

2011 – 12 Add-On Carry Over:

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (8)
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4. 2019 – 2020 Facility-Specific Reimbursement Rates Established for FS/NF-Bs

Effective for dates of service on or after August 1, 2019, the 2019 – 2020 facility-specific reimbursement rates for Free-Standing Nursing Facilities Level B (FS/NF-Bs) are established.

The 2019 – 2020 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 rates to bill for dates of service on or after August 1, 2019. 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 2019 – 2020 rates are based upon the facility's 2017 audited cost report data. The 2019 – 2020 rates are adjusted for new 2019 – 2020 mandates and capped to adhere to program-budgeted amounts.

Mandates
The 2019 – 2020 rate year mandates total $2.95. The components include the following:

Description Rate
2018 minimum wage (Senate Bill 3) $0.57
2019 minimum wage (SB 3)   0.55
2020 minimum wage (SB 3)   0.50
LGBT   0.02
Standards of participation   1.31

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.

Leave of Absence/Bed Hold Reduction
The 2019 – 2020 reduction for leave of absence or bed hold is $8.35.

Quality Assurance Fee (QAF)
The approved FS/NF-B QAF amount for facilities reporting fewer than 100,000 days is $15.68. The approved FS/NF-B QAF amount for facilities reporting 100,000 days or more is $14.80.

2019 – 2020 Rate Year Peer Group Weighted Averages
Peer Group ID Includes QAF Excludes QAF
1 $197.23 $181.55
2   232.72   217.04
3   233.42   217.74
4   251.07   235.39
5   217.26   201.58
6   222.74   207.06
7   256.04   240.36
Statewide Weighted Average   229.00   213.32

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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5. 2019 – 2020 Facility-Specific Reimbursement Rates Established for FSSA/NF-B

For dates of service on or after August 1, 2019, the 2018 – 2019 facility-specific reimbursement rates for Free-Standing Adult Subacute Skilled Nursing Facility Level B (FSSA/NF-B) are established.

The final rates are posted on the Long-Term Care Reimbursement Assembly Bill 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, 2019. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No additional action is required of providers.

FSSA/NF-B facility-specific reimbursement rates are calculated annually. The 2019 – 2020 rates are based on the audited costs for facility fiscal periods ending in 2017.

The final rates are adjusted for new 2019 – 2020 state and federal mandates. The 2019 – 2020 rate year mandates total $2.95, including the following:

Description Rate
January 2020 minimum wage (Senate Bill 3) $ 0.50
January 2019 minimum wage (Senate Bill 3)   0.55
January 2018 minimum wage (Senate Bill 3)   0.57
Standards of participation   1.31
LGBT   0.02

The 2019 – 2020 rate reduction for leave of absence or bed hold is $8.35.

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6. Rural Hospital Swing Bed Rates Updated for 2019

Effective for dates of service on or after August 1, 2019, the rural swing bed rates for accommodation codes 04 (regular services) and 05 (leave of absence/bed hold) are updated.

Rural Swing Bed rates are exempt from the Assembly Bill 97, 10 percent payment reduction, but are subject to the AB 97 rate freeze at the reimbursement rate established in 2008 – 2009 including any applicable add-ons. However, retroactive to September 1, 2013, Distinct Part-Nursing Facilities Level B (DP/NF-Bs) located in designated rural or frontier areas are exempt from the AB 97 rate freeze.

Effective August 1, 2019, the rural swing bed rates in hospitals located in designated rural/frontier areas with DP/NF-Bs are exempt from the AB 97 rate freeze.

Rural Swing Bed
(exempt from AB 97 rate freeze)
Accommodation Code Rate
04 $436.64*
05 $428.29**
*     Includes 2019 $1.62 unfrozen add-ons
**   2019 leave of absence/bed hold rate of $8.35

Effective August 1, 2019, the rural swing bed rates for rural hospitals that do not have a DP/NF-B are not exempt from the AB 97 rate freeze.

Rural Swing Bed
(not exempt from AB 97 rate freeze)

Accommodation Code Rate
04 $312.07*
05 $303.72**
*     Includes 2008 rate of $305.15 plus 2019 $6.92 frozen add-ons
**   2019 leave of absence/bed hold rate of $8.35

Providers do not need to rebill to adjust their reimbursements. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

For billing or reimbursement questions, providers may call the Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday.

The rural swing bed rates are available on the Rural Swing Bed page of the Department of Health Care Services (DHCS) website.

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (6)
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7. 2020 Medi-Cal Provider Training Schedule

The 2020 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 7 – 30 Webinar Information posted on the Medi-Cal website
February 11 – 12 Seminar Santa Ana
Double Tree by Hilton
201 East MacArthur Blvd.
Santa Ana, CA  92707
March 5 Seminar Concord
Crowne Plaza
45 John Glenn Drive
Concord, CA  91764
March 24 Seminar Santa Rosa
Flamingo Conference Resort & Spa
2777 Fourth Street
Santa Rosa, CA  95405
April 14 – 15 Seminar Riverside
Riverside Convention Center
3637 Fifth Street
Riverside, CA  92501
May 12 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
June 2 – 30 Webinar Information to be published on Medi-Cal website
July 29 – 30 Seminar Escondido
California Center for the Arts
340 North Escondido Blvd.
Escondido, CA  92025
August 26 – 27 Seminar Sacramento
Sacramento Marriott
11211 Point East Drive
Rancho Cordova, CA   95742
September 15 – 16 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
October 14 – 15 Seminar Fresno
Double Tree Hilton
2233 Ventura Street
Fresno, CA  93721
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8. January 2020 Medi-Cal Provider Training Webinars

Beginning January 7, 2020, and continuing throughout the month of January, Medi-Cal providers may participate in provider training webinars that are:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

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9. February 2020 Medi-Cal Provider Seminar

The February Medi-Cal provider seminar is scheduled for Feb. 11 – 12, 2020, at the Santa Ana Double Tree by Hilton in Santa Ana, California. Providers can access a class schedule for the seminar by visiting the Provider Training webpage of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging into the MLP.

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

Providers must register by January 24, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 24, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks webpage 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 request a custom billing workshop presented by a regional field representative. To schedule the regional representative for your area, providers must contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

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

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10. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

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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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