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

March 30, 2021

The January 1, 2021, to December 31, 2021, (Calendar Year [CY] 2021) facility specific reimbursement rates for Freestanding Nursing Facilities Level B (FS/NF-B) are established effective for dates of service on or after January 1, 2021.

The FS/NF-B facility-specific reimbursement rates are computed on an annual basis. The CY 2021 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 coronavirus disease 2019 (COVID-19) increased reimbursement of 10 percent, which is based on the facility’s prior 2019 – 2020 facility-specific rate. The 10 percent increase will be provided during the coronavirus public health emergency and national emergency and will end at the expiration of either emergency period. The temporary COVID-19 increased rates are posted on the website listed above.

Providers should use these rates to bill for dates of service on or after January 1, 2021. An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims. No additional action is required of providers.

Mandates

The CY 2021 rate period add-ons total $3.82. This includes Minimum Wage (January 2021, SB 3) $1.08, Minimum Wage (January 2020, SB 3) $0.86, and Minimum Wage (January 2019, SB 3) $0.55, Standards of Participation: Infection Preventionist $1.31, and LGBT $0.02. Additionally, there is an add-on for the SB 97 Staffing Standard Mandate that is calculated on a facility-specific basis.

These rates are posted on the Long-Term Care Reimbursement AB 1629 web page of the Department of Health Care Services (DHCS) website. 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 2021 rate period reduction for Leave of Absence or Bed Hold is $8.73.

Quality Assurance Fee (QAF)

Approved FS/NF-B Quality Assurance Fee (QAF) amount for facilities reporting less than 100,000 days is $15.19, and $14.54 for facilities reporting equal to or greater than 100,000 days.

CY 2021 Rate Period Peer Group Weighted Averages Table

Peer Group ID Includes QAF Without QAF
1 $255.99 $239.23
2 $304.77 $288.01
3 $310.71 $293.95
4 $295.47 $278.71
5 $283.20 $266.44
6 $273.63 $256.87
7 $267.71 $250.95
8 $256.30 $239.54
9 $237.73 $220.97
10 $262.21 $245.45
11 $255.65 $238.89
Statewide Weighted Average $270.66 $253.90