California Skilled Nursing Facilities:
New Medi-Cal Rates for FY 2018/2019, Retroactive to 8/1/2018

February 22, 2019

The State of California has now posted FINAL rates for Skilled Nursing Facilities (SNF's) and Subacute Facilities for fiscal year 2018/2019, which will be retroactive to 8/1/2018.

Here are the highlights:

  • Included in the rates is an across the board mandated pass-through of $3.13 per day for mandated new costs. (See below for breakdown).
  • The new Quality Assurance fee is $15.72 per day (for facilities with less than 100,000 days per year), up from $15.38.
  • The new Bed Hold rate is $7.92 per day, up from $7.65.

Details on the Final Published Rates:

  1. Now that the Final rates have been published, the State will be comparing each facility’s new rate with the previous final rate that was paid from August 2018.
  2. For facilities that have an increase above the previous final rate, a lump sum will be calculated and paid based on the number of Medi-Cal patient days paid.
  3. For facilities that have a reduction from the previous final rate, a calculation will be made of the over-payment. This is normally recovered at the rate of 5% of the total from each succeeding check write, however we don’t have confirmation of this yet.
  4. On the average, it takes the State approximately 7-10 months to pay/recover any amounts. Facilities receiving payments for Medi-Cal residents from Managed Care plans should receive these rates. We have no information yet regarding any individual plan’s intentions regarding timing of new payments.

Sub Acute Rates

The State has also posted Sub Acute rates for 2018/19, which will be retroactive to 8/1/2018. The across the board pass-through of $3.13 per day for mandated new costs also apply to the Sub Acute rates. (See below for breakdown).

Institutions for Mental Diseases

The final 2018/2019 rates have not been posted for IMDs.

Mandated Pass-Throughs

The State included the following additional amounts in the rates:

2017 Minimum Wage SB 3 $0.07
2018 Minimum Wage SB 3 $1.36
2019 Minimum Wage SB 3 $0.32
LGBT SB 219 $0.06
Standards of Participation $1.32

There is an additional add-on for the staffing standard mandate (SB 97) that is calculated on a facility-specific basis.

Please note: Mueller Prost Rate Estimates issued during cost report time are not based on any state interim rates issued, but are estimated based on final rates issued from year-to-year. The final rates for 2018/19 should be compared to your rate issued in 2017/18, plus your issued Medi-Cal audited adjustments.

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

Below please find links to the rate schedules. Please note that, currently, the build-up detail and FRVS schedule are not posted online. We will add these downloads to our website and send another email alert when they are posted.

*Accomodation codes:
  01 - NF-B Regular, Regular Services
  02 - NF-B Regular, Leave Days Non-DD Patient
  03 - NF-B Regular, Leave Days DD Patient
  11 - NF-B Special Treatment Program - Mentally Disordered, Regular Services
  12 - NF-B Special Treatment Program - Mentally Disordered, Leave Days Non-DD Patient

 

We hope you find this information valuable. As always, we are here to help. Contact us with questions about the new rates or to start a conversation.

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