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CA Skilled Nursing Medi-Cal Rates Released

Tiffany Karlin

April 08, 2021

The State of California Department of Health has posted FINAL rates for Skilled Nursing Facilities (SNF’s) and for Subacute Facilities (for rate year 2021), retroactive to 01/01/2021. 

Please note, due to the passage of AB-81 changing the rate year to a calendar year-end, these newest rates reflect a three (3) rate setting report based on 2018 as filed cost reports.

DETAILS ON FINAL PUSLISHED RATES:

  1. Now that final rates have been published, the State will be comparing each facility’s new rate with the previous final rate paid during August 2020 – December 2020.
  2. For facilities with 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 with a reduction from the previous final rate, a calculation will be made of the overpayment. This is normally recovered at 5% of the total from each succeeding check written, however we don’t have confirmation of this amount.
  4. On average, it takes the State approximately seven to ten months to pay/recover any amounts.

Facilities receiving payments for Medi-Cal residents from Managed Care plans should receive these rates. We do not yet have regarding any individual plan’s intentions regarding timing of new payments.

Subacute rates. The State has also posted Subacute rates for 2021, retroactive to 1/1/2021. 

Please note: Mueller Prost “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. Further, these rates are “estimates”. The final rates for 2021 should be compared to your rate issued in 2019/20, plus your issued Medi-Cal audited adjustments.

This rate includes the 10% COVID add-on. Upon expiration of the public health emergency or national emergency, whichever occurs first, LTC reimbursements will revert to their regular facility-specific levels. Mueller Prost will issue a client alert when the add-on has expired.

As more unfolds with reporting and audit requirements of the 10% COVID add-on, Mueller Prost is advising all clients to track this incoming revenue separately, then your set Medi-Cal reimbursement. These payments are a total on your remittance advice (RA), so you will need to review and determine the 10% add on, and maintain separate documentation of incurred revenue to the corresponding COVID related expense.

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

*Currently the “build-up detail” is not posted on-line, nor is the FRVS schedule, peer group caps or QA Fee Rates. We will update this on our website once these are posted.

  • 2021 SNF-B Rate File*
  • 2021 FSSA Rate File*

*Accommodation Code 01 – NF-B Regular, Regular Services
Accommodation Code 02 NF-B Regular, Leave Days Non-DD Patient
Accommodation Code 03 NF-B Regular, Leave Days DD Patient
Accommodation Code 11 – NF-B Special Treatment Program – Mentally Disordered, Regular Services
Accommodation Code 12 NF-B Special Treatment Program – Mentally Disordered, Leave Days Non-DD Patient

We can assist with any reporting concerns. Please contact our team or your Mueller Prost specialist directly.

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