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California State Plan Amendment to Increase Medi-Cal Rates for Long Term Care Providers by 10%

Tiffany Karlin

May 14, 2020

Centers for Medicare and Medicaid Services approved California’s proposed State Plan Amendment (SPA) to increase Medi-Cal rates for providers by 10% to Freestanding Nursing Facilities Level-B; Nursing Facilities Level-A; Distinct Part Nursing Facilities Level-B; Freestanding Adult Subacute Facilities; Distinct Part Adult Subacute Facilities; Distinct Part Pediatric Subacute facilities; Freestanding Pediatric Subacute facilities) and ICF/DD (including ICF/DDs, ICF/DD-Habilitative, and ICF/DD-Nursing) per diem rates. The increase will be retroactive to March 1, 2020, and will stay in place during the duration of the “COVID-19 pandemic” (no specific date specified). SPA language available here.

This increase would not apply to state-owned SNFs or ICFs, including Developmental Centers and Veterans Homes. These rates include: add-ons, the Freestanding Pediatric Subacute Facility supplemental payments and the ICF/DD supplemental payments, but exclude: ancillary charges and other supplemental payments, including, the Quality and Accountability Supplemental Program, the ICF/DD day treatment supplemental payment and the Special Treatment Program (STP) Patch.

Other Amendments:

  1. Allows hospitals to make presumptive eligibility determinations for:
    1. Individuals eligible for but not receiving cash assistance
    2. Individuals receiving Home and Community Based Services
    3. Optional state supplemental beneficiaries
    4. PACE enrollees
    5. Age and disability poverty level
    6. Work incentives
    7. Uninsured individuals
  2. Suspends deductibles, copayments, coinsurance and other cost sharing for testing services and treatments related to COVID-19
  3. Modify the face-to-face requirement to be provided via all forms of telehealth
  4. Removal of the six-prescription per calendar month limitation on covered outpatient drugs. Providers may dispense up to the 100-day supply at one time of all covered outpatient drugs.
  5. Allows for In-Home Supportive Services Individual Provider Rate (IHSS), to include payment for paid time off of IHSS providers related to COVID-19 sick leave benefits
  6. Interim reimbursement payments for Drug Medi-Cal non-Narcotic Treatment Program and Specialty Mental Health Services

Governor Newsom is expected to submit the revised budget proposal- “May Revision”- to the California Legislature for the state fiscal year that will start on July 1st.  It is anticipated that current AB1629 SNF Rate Model scheduled to sunset June 30th will be extended and new proposed rate system delayed. More details to come on this.

Information presented is real time and is what we know today, as more concrete details are released, future emails will be sent.

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