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Medi-Cal Update

Long Term Care | May 2022 | Bulletin 543

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1. Medi-Cal Subscription Service is Coming Back

++An article titled “Medi-Cal Subscription Service (MCSS) is Live” is now posted to the News Flash area of the Part 1 Provider Communications section of the Medi-Cal website. Refer to this article for the most recent status of and instruction regarding MCSS.

Overview

The Department of Health Care Services (DHCS) is pleased to announce that the Medi-Cal Subscription Service (MCSS) is returning.

For providers and Medi-Cal stakeholders unfamiliar with the service, MCSS is a free service that sends subscribers subject-specific emails based on the provider communities they have subscribed to. This keeps subscribers up-to-date when urgent announcements and other updates post to the Medi-Cal Providers website.

DHCS took the service down in October 2021 to address some necessary changes. The returning MCSS retains the functionality and look-and-feel of the service subscribers are familiar with. However, DHCS wishes to highlight one change and one action required of subscribers to ensure they receive MCSS emails once the service is turned back on:

  • Sent From Email Changed: Emails received via MCSS will be sent from the following email address: do-not-reply_MCSSCalifornia@gainwelltechnologies.com.

  • Subscriber Action: The first few messages from MCSS may appear in spam or promotional inboxes. To avoid this, and to ensure they receive the latest messages from Medi-Cal fee-for-service, subscribers are instructed to add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their list of approved senders. Note that the exact instructions on how to add an email to the list of approved senders, will change depending on the email client in use. Medi-Cal has identified some frequently used email domains and resources on how to manage an approved senders list:

  • Subscribers who have alternative email domains not listed above (for example, @companyname.com), should defer to their company’s IT group or the email provider they use for their business, to ensure MCSSCalifornia@gainwelltechnologies.com is listed as an approved sender.

  • Without taking action to add MCSSCalifornia@gainwelltechnologies.com to the list of approved senders, it is possible that MCSS messages will either be blocked from the subscriber’s account or be filtered into Spam/Promotional folders.

Returning MCSS Subscribers

DHCS recommends existing subscribers add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their approved sender list to resume receiving MCSS emails. This is the only action needed. You do not need to re-subscribe for MCSS. Subscribers should keep an eye out for a “Welcome Back” email in the near future to see if they have appropriately added do-not-reply_MCSSCalifornia@gainwelltechnologies.com to the approved senders list.

DHCS will not send MCSS emails for publications published between October 2021 and May 2022. Instead, the “Welcome Back” email will highlight major changes and point to additional resources on any missed updates. Medi-Cal apologizes for any inconvenience this may cause.

Existing Subscribers can update their subscription preferences through a link in the footer of MCSS emails they receive. Only the most recent MCSS email will properly update subscription preferences.

New MCSS Subscribers

New subscribers can either sign up now using the current MCSS Subscription Form, or when MCSS returns using the updated online form. New subscribers using the current MCSS Subscription Form will not receive any emails until MCSS returns and the “Welcome Back” email is sent. New subscribers who sign up when MCSS returns will receive a “Welcome to MCSS” email. New subscribers should add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their approved senders list.

What’s Next

A News article will be published on the Medi-Cal Providers website once MCSS and MLP surveys are officially brought back online, and the “Welcome Back” emails begin to be sent out. DHCS is projecting that this will occur in late May or early June 2022.

Additionally, for all MCSS subscribers, refer to the updated Med-Cal Subscription Service (MCSS) Help page to find more information about this service.

2. Freestanding Pediatric Subacute Rates are Updated

Effective for dates of service on or after August 1, 2021, reimbursement rates for Freestanding Pediatric Subacute (FS/PSA) facilities have been updated. Providers should begin using these rates to bill for services. The rates have been posted on the Long-Term Care Reimbursement AB 1629 web page.

Final FS/PSA Reimbursement Rates

Contingent on federal approval of State Plan Amendment 21-0059, the FS/PSA rates effective August 1, 2021, and each rate period thereafter are no longer frozen at 2008–2009 levels. For the projected estimate of the unfrozen 2008–2009 FS/PSA rates, the Department of Health Care Services (DHCS) inflated the FS/PSA labor and non-labor cost per diems forward through the 2021–2022 rate period and adjusted for new federal or state mandates including the Proposition 56 supplemental payment.

This estimate was compared to the upper median per diem cost of FS/PSAs, calculated by inflating FS/PSA Fiscal Year End (FYE) 2019 audited cost data through the 2021–2022 rate period, adjusted for changes in federal or state mandates and inclusive of the Proposition 56 supplemental payment. DHCS estimated a 74 percent to 26 percent ratio of labor to non-labor costs, based on the total audited costs of FYE 2018 Freestanding Subacute Nursing Facility Level-B facilities, and inflated the FS/PSA total audited costs for labor and non- labor based on this ratio.

The median cost based per diem was found to be the lesser of the two calculated rates, and greater than the FS/PSA frozen 2008–2009 rate level. The FS/PSA rates effective August 1, 2021, are listed in the table below:

New FS/PSA Rates
Code 91 92 93/95 94/96 97 98
Rate $1,134.10 $1,021.67 $1,125.16 $1,012.72 $83.92 $78.24

The below list of add-ons are not applied to rehabilitation therapy and ventilator weaning rates. 2020–2022 add-ons:

  • 2022 Minimum Wage ($0.53)

  • 2021 Minimum Wage ($1.08)

  • 2020 Minimum Wage ($0.36)

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously paid based on the previous rate because Medi-Cal had not yet implemented the system changes to support appropriate adjudication.

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (8, 9)

3. Distinct Part Pediatric Subacute Rates are Updated

Effective for dates of service on or after August 1, 2021, reimbursement rates for Distinct Part Pediatric Subacute (DP/PSA) facilities have been updated. Providers should begin using these rates to bill for services. The rates have been posted on the Long-Term Care Reimbursement AB 1629 web page.

DP/PSA Reimbursement Rates

DP/PSA reimbursement rates effective August 1, 2021 are based on costs as projected by the Department of Health Care Services (DHCS), as well as the cost of new state or federal mandates (add-ons). The calculated ventilator dependent rate is $1,367.30 and the non-ventilator rate is $1,252.76. The add-ons are not applied to rehabilitation therapy and ventilator weaning rates.

New DP/PSA Rates
Code 83 84 85 86 87/89 88/90
Rate $85.45 $79.66 $1,367.30 $1,252.76 $1,358.35 $1,243.81

2021–2022 add-ons:

  • Minimum Wage (January 2022 SB 3) ($0.53)

  • Minimum Wage (January 2021 SB 3) ($1.08)

  • Minimum Wage (January 2020 SB 3) ($0.36)

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously paid based on the previous rate because Medi-Cal had not yet implemented the system changes to support appropriate adjudication.

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (8, 9)

4. Temporary Increased COVID-19 Freestanding Skilled Nursing Facility Level B Rates

Effective for dates of service on or after January 1, 2022, reimbursement rates for Freestanding Nursing Facilities Level B (FS/NF-B) have been updated. The FS/NF-B facility-specific reimbursement rates are computed on an annual basis. The Calendar Year (CY) 2022 rates are posted on the Long-Term Care Reimbursement AB 1629 web page of the Department of Health Care Services (DHCS) website.

In addition, the facility-specific rates include a temporary COVID-19 increased reimbursement of 10 percent, which was calculated based on the facility’s prior 2019-20 facility-specific rate. The 10 percent increase will be provided during the coronavirus public health emergency (PHE) and national emergency and will end at the expiration of the emergency period.

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously paid based on the previous rate because Medi-Cal had not yet implemented the system changes to support appropriate adjudication.

Mandates

The CY 2022 rate period add-ons total $2.84. This includes the following add-ons:

  • Minimum Wage (January 2022, SB 3) $0.90

  • Minimum Wage (January 2021, SB 3) $1.08

  • Minimum Wage (January 2020, SB 3) $0.86

Providers should use these rates to bill for services.

Change of Ownership

Facilities with changes of ownership or changes of licensed operator do not qualify for facility specific reimbursement rates and will continue to receive the prior owner’s or licensed operator’s rate. For more information, please refer to the AB 1629 Facility-Specific Rate Methodology Clarifications article on the DHCS website.

Leave of Absence/Bed Hold Reduction

The CY 2022 rate period reduction for Leave of Absence or Bed Hold is $8.93.

Quality Assurance Fee (QAF)

The FS/NF-B Quality Assurance Fee (QAF) amount for facilities reporting less than 100,000 days is $16.96, and $16.08 for facilities reporting equal to or greater than 100,000 days.

CY 2022 Rate Period Peer Group Weighted Averages Table

Peer Group ID Includes QAF Without QAF
1 $256.06 $246.53
2 $315.35 $296.82
3 $317.22 $298.69
4 $306.31 $287.78
5 $288.13 $269.60
6 $282.27 $263.74
7 $273.46 $254.93
8 $263.02 $244.49
9 $242.47 $223.94
10 $271.47 $252.94
11 $265.69 $247.16
Statewide Weighted Average $278.48 $259.95

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (2–4)

5. Temporary Increased COVID-19 Freestanding Subacute Skilled Nursing Facility Level B Rates

Effective for dates of service on or after January 1, 2022, reimbursement rates for Freestanding Adult Subacute Skilled Nursing Facilities Level B (FSSA/NF-B) have been updated. The FSSA/NF-B facility-specific reimbursement rates are computed on an annual basis. The Calendar Year (CY) 2022 rates are posted on the Long-Term Care Reimbursement AB 1629 web page of the Department of Health Care Services (DHCS) website.

In addition, the facility-specific rates include a temporary COVID-19 increased reimbursement of 10 percent, which was calculated based on the facility’s prior 2019-20 facility-specific rate. The 10 percent increase will be provided during the COVID-19 public health emergency and national emergency and will end at the expiration of the emergency period.

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after January 1, 2022, that were appropriately submitted based on the guidance published in this article, but erroneously paid based on the previous rate because Medi-Cal had not yet implemented the system changes to support appropriate adjudication.

Mandates

The CY 2022 rate period add-ons total $2.84. This includes the following add-ons:

  • Minimum Wage (January 2022, SB 3) $0.90

  • Minimum Wage (January 2021, SB 3) $1.08

  • Minimum Wage (January 2020, SB 3) $0.86

Change of Ownership

Facilities with changes of ownership or changes of licensed operator do not qualify for facility specific reimbursement rates and will continue to receive the prior owner’s or licensed operator’s rate. For more information, please refer to the Long-Term Care Reimbursement AB 1629 page on the DHCS website.

Leave of Absence/Bed Hold Reduction

The CY 2022 rate period reduction for Leave of Absence or Bed Hold is $8.93.

Quality Assurance Fee

The FS/NF-B Quality Assurance Fee amount for facilities reporting less than 100,000 days is $16.96.

6. LTC Providers Will Transition to the UB-04 Claim Form

To comply with federal Health Insurance Portability and Accountability Act (HIPAA) requirements, the Department of Health Care Services (DHCS) will transition away from the use of local Long Term Care facility service codes and the local Payment Request for Long Term Care (LTC) 25-1 form. Instead, DHCS will process LTC facility claims using the National Uniform Billing Committee (NUBC) UB-04 Data Specifications Manual codes and data elements submitted on a UB-04 claim form.

Once DHCS has determined that LTC providers are ready to accept these changes, they should be prepared to do the following:

  • Submit LTC facility claims using a NUBC UB-04 claim form, one claim form per recipient.

  • Use NUBC UB-04 codes and data elements such as revenue codes, value codes and amounts, and patient discharge status codes.

  • Obtain UB-04 claim forms directly from a vendor such as a commercial retailer or office supply store. Claim forms must include red “drop-out” ink to meet federal Centers for Medicare & Medicaid Services (CMS) standards.

For this update, DHCS will offer various education and training resources to help prepare providers for this transition:

  • A new LTC Claim Form and Code Conversion web page that includes the most up-to-date news about the conversions.

  • Training seminars and webinars featuring instructions on how to complete the UB-04 claim form and the Treatment Authorization Request (TAR).

  • A billing code crosswalk between the local service codes and the NUBC UB-04 codes and data elements.

  • Provider manual instructions on how to complete a UB-04 claim form for LTC facility services.

  • Updates to the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual.

DHCS will maintain current provider billing support services:

  • Technical support with the 837I transaction via the Telephone Service Center (TSC) available at 1-800-541-5555.

  • One-to-one, on-site provider trainings and assistance from a Medi-Cal Provider Field Representative available on request by calling the TSC at 1-800-541-5555.

For updated information on the LTC code and claim form conversion, LTC providers are encouraged to regularly check the LTC Claim Form and Code Conversion web page.

7. Billing Multiple NCCI Modifiers Together and Additional NCCI Webpage Resources

As previously announced in the article titled “Multiple NCCI Modifiers Now Billable Together,” multiple National Correct Coding Initiative (NCCI) modifiers may be billed on the same claim line if it is appropriate and medically justified. In particular, claims may have more than one NCCI associated modifier applied to a claim line only when medically necessary, as documented in the medical record, and in accordance with the Medicaid NCCI program and HCPCS and CPT® guidelines for the modifier and procedure code combination. Providers can refer to Correct Coding Initiative: National section in the appropriate Part 2 manual for instructions regarding the appropriate use of NCCI-associated modifiers.

The Correct Coding Initiative: National manual section also includes direction specifically on how providers should complete claims to bypass any potential NCCI edit when they:

  • Perform the same service on the same date for a newborn and the mother or;

  • Perform the same service on the same day for newborns in a multiple birth scenario.

Additionally, the following resource list from the Centers for Medicare & Medicaid Services (CMS) Medicaid NCCI website have been added to the NCCI web page:

  • NCCI Policy Manual for Medicaid Services

  • The Medicare Learning Network (MLN) booklet, “How to Use the Medicaid National Correct Coding Initiative (NCCI) Tools”

  • Complete Medicaid NCCI Edit Files

  • Medicaid Change Reports

  • Proper Use of Modifiers 59 & - X{EPSU}

  • Medicaid NCCI Correspondence Language Manual

  • Medicaid NCCI FAQs
Provider Manual(s) Page(s) Updated
Acupuncture
Chiropractic
appeal form (7); cif co (3); cms comp (15, 21); remit adv (3); remit pay (3)
AIDS Waiver Program
Home Health Agencies/Home and
Community-Based Services
Vision Care
appeal form (7); cif co (3); correct (1–7); correct cod (1); modif app (1); remit adv (3); remit pay (3)
Audiology and Hearing Aids
Therapies
appeal form (7); cif co (3); cms comp (15, 21); correct (1–7); correct cod (1); modif app (1); remit adv (3); remit pay (3)
Chronic Dialysis Clinics
Clinics and Hospitals
Rehabilitation Clinics
appeal form (7); cif co (3); correct (1–7); correct cod (1); modif app (1); modif used (2); remit adv (3); remit pay (3)
Community-Based Adult Services
Heroin Detoxification
Multipurpose Senior Services Program
appeal form (7); cif co (3); correct (1–7); correct cod (1); remit adv (3); remit pay (3)
Durable Medical Equipment appeal form (7); cif co (3); cms comp (15, 21); correct (1–7); correct cod (1); modif app (1); remit adv (3); remit pay (3)
General Medicine
Obstetrics
appeal form (7); cif co (3); cms comp (15, 21); correct (1–7); correct cod (1); modif app (1); modif used (2); preg ex cms (5, 7); remit adv (3); remit pay (3)
Hospice Care Program
Inpatient Services
Long Term Care
appeal form (7); cif co (3); remit adv (3); remit pay (3)
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
appeal form (7); cif co (3); modif app (1); remit adv (3); remit pay (3)
Medical Transportation appeal form (7); cif co (3); cms comp (15, 21); remit adv (3); remit pay (3)
Orthotics and Prosthetics appeal form (7); cif co (3); cms comp (15, 21); correct (1–7); correct cod (1); modif app (1); ortho ex (5); remit adv (3); remit pay (3)
Pharmacy appeal form (7); cif co (3); cms comp (15, 21); ortho ex (5); remit adv (3); remit pay (3)
Psychological Services appeal form (7); cif co (3); cms comp (15, 21); correct (1–7); correct cod (1); remit adv (3); remit pay (3)

8. Claims Reimbursement Update for Medical and Incontinence Supplies

Effective for dates of service on or after October 1, 2020, the California State Plan Amendment (SPA) 20-0035 updates the Medi-Cal prescriber requirements for medical supplies and incontinence supplies.

Claims for covered medical and incontinence supplies provided upon a prescription are eligible for reimbursement if the prescription is written by a physician, nurse practitioner (NP), clinical nurse specialist (CNS) or a physician assistant (PA) within their scope of practice. Code of Federal Regulations (CFR) Title 42, Section 440.70, requires Medicaid programs to only reimburse providers for medical and incontinence supplies written by a physician, MP, CNS or PA.

In addition to the policy changes, the following spreadsheets are retired from the Medi-Cal website and are available on the Medi-Cal Rx website:

  • List of Contracted Diabetic Test Strips and Lancets

  • List of Contracted Pen Needles

  • List of Contracted Sterile Needles

The Medical Supplies and Incontinence sections of the provider manual have been updated to clarify the prescriber requirements.

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
enteral (1–4); incont (1, 5); incont ex (1); mc sup (1–3, 6–10, 13)
Clinics and Hospitals
General Medicine
incont (1, 5); non ph (1); cal child sar (12)
Obstetrics
Rehabilitation Clinics
cal child sar (12); nonph (1, 4)
Audiology and Hearing Aids
Chronic Dialysis Clinics
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Psychology Services
Therapies
Vision Care
cal child sar (12)
Long Term Care incont (1, 5)

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

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

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

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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