Retroactive Medi-Cal Rates Posted for Skilled Nursing Facilities

July 21, 2016

The State of California has now posted FINAL rates for Skilled Nursing Facility's (SNF’s) for fiscal year 2015/2016, which will be retroactive to 8/1/2015.  Here are the highlights: 

  • Included in the rates is an across the board mandated pass-through of $3.36 per day for mandated new costs. (See below downloads for breakdown).
  • The new Quality Assurance fee is $16.26 per day (for facilities with less than 100,000 days per year), up from $16.03.
  • The new Bed Hold rate is $7.08 per day, up from $6.84.

Information regarding the interim increase previously provided:

  1. Now that the final rates have been published, the state will be comparing each facility’s new rate with the interim rate that was paid from January 2016.

  2. For facilities that have an increase above the interim rate, a lump sum will be calculated and paid based on the number of Medi-Cal patient days paid. From previous experience, we cannot expect this to happen quickly.

  3. For facilities that have a reduction from the interim rate, a calculation will be made of the over-payment. We believe this will be this will be recovered at the rate of 5% of the total from each succeeding check write.

  4. We have no information yet regarding when either lump sums or take-backs will happen.

The interim 2015/16 rates were calculated increasing the 2014/15 rates across the board by 3.62%.  Unfortunately this is not in line with the 2015/16 rates that were published.  We will be analyzing everyone’s rate in the coming week to determine the specifics as to the reason why your final 2015/16 rate decreased.

Sub Acute Rates: The state has also posted sub acute rates for 2015/2016, which will be retroactive to 8/1/2015.  The across the board pass-through of $3.36 per day for mandated new costs also apply to the sub acute rates.  (See below download for breakdown)

Institutions for Mental Diseases: These rates have not yet been announced.

Mandated Pass-Through Costs: The State included the following additional amounts in the rates:

  • Minimum Wage - ($0.27)
  • Federal Unemployment Tax Act (FUTA Insurance) - ($0.33)
  • Affordable Care Reporting - ($0.54)
  • ICD-10 Transition from ICD-9 - ($0.50)
  • Paid Sick Leave - ($1.72)

We are aware that some of you may be receiving less than the interim rate issued earlier this year. Please note: From our previous client alert concerning the interim rate, due to the state not being timely with rate adjustments, they issued increases in rates without much analysis made to peer groups, audits, etc. Therefore any rate increases at the time should have been taken with a “grain of salt” as that money may have to be paid back at time of final rates issued (which some of you are now experiencing).

Our rate estimates issued during cost report time are not based on any state interim rates issued, but on final rates issued from year to year. These final rates for 2015/16 should be compared to your rate issued in 2014/15, plus your issued Medi-Cal audited adjustments.

Rest assured, we are working diligently this week to review all rates and perform rate analysis to determine causes for any rate reductions from prior year 2014/15 rates that might have occurred. We will be in touch with you should we find that an analysis is necessary based on a drop in rate.


Rate Schedule Downloads (from the California Department of Health Care Services):

We hope you find this information valuable.  As always, we are here to help.  If you have any questions or would like to discuss these changes, please contact us or reach out to Tiffany Karlin directly.

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