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California Skilled Nursing Medi-Cal Temporarily Increased Rates Have Been Released – September 2020

Tiffany Karlin

September 14, 2020

In a follow-up to our client alert on July 23rd, The State of California Department of Health has now posted Medi-cal rates for Skilled Nursing Facilities (SNF’s) and for Subacute Facilities for August 1, 2020, through December 31, 2020, which will be retroactive to 8/1/2020. 

IMPORTANT NOTE: These rates are temporary and only for the period of August 1, 2020, through December 31, 2020.  New rates as detailed in our guidance from our prior client alert will be issued at the start of 2021.

DETAILS ON FINAL PUSLISHED 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 2020.
  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 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 average, it takes the State approximately 7-10 months to pay/recover any amounts.
  5. These rates include the 10% COVID Add-on.

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 the timing of new payments.

Sub-Acute rates: The State has also posted Sub Acute rates for August 1, 2020, through December 31, 2020, which will be retroactive to 8/1/2020. 

Billing: Now that the new rates have been published, billing should include the new rates to ensure processing of the automatic retroactive payments we’ve become accustomed to.

The rates published have not yet been loaded into the payment system, once this is done, this will trigger the payment corrections retroactive to August 1st 2020.

When reviewing the rate file, be sure to locate your facility using the column filters, and ensure that you are updating the rates for the correct accommodation codes, based on in house or bed hold status.

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.

*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

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