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CLIENT ALERT: California Skilled Nursing Facilities: New Medi-Cal Rates for FY 2019/2020, Retroactive to 8/1/2019

Medical healthcare and doctor service
Nancy Helstrom

February 03, 2020

The State of California has now posted FINAL rates for Skilled Nursing Facilities (SNF’s), Subacute Facilities and Intuitions for Mental Diseases (IMDs) for fiscal year 2019/2020, which will be retroactive to 8/1/2019 (and July 1, 2019 for IMDs). 

Here are the highlights: 

  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 1, 2019.
  2. Those 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. Those facilities that have a reduction from the previous final rate, a calculation will be made of the overpayment. 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. There has been no information yet regarding any individual plan’s intentions regarding timing of new payments. 

Please note: There are only very limited details published and these rates may still have some adjustments to be made to them. Mueller Prost will be following up with further alerts as new information unfolds.

Further, 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 2019/20 should be compared to your rate issued in 2018/19, plus your issued Medi-Cal audited adjustments.

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.

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