What’s happening: Last week, the California Department of Health Care Services (DHCS) posted updated payment rates for distinct-part nursing facilities (DP-NF) and distinct-part subacute facilities (DP-SA) for adults and pediatrics.
What else to know: Now that DP-NF and DP-SA services have been fully carved into Medi-Cal managed care plans’ (MCPs) scope of benefits, DHCS has implemented a policy that transitions the DP-NF and DP-SA rate year to a calendar year to align with the Medi-Cal managed care rate year.
As a result, DHCS released two sets of rates for each DP-NF and DP-SA based on the dates of service. DHCS’ release includes one set of rates covering Aug. 1, 2023, through Dec. 31, 2023, and another set of rates covering Jan. 1 through Dec. 31, 2024. DHCS will issue rate letters to each facility with their rates for each time period in the coming weeks. DHCS will also run an electronic payment correction (EPC) and reprocess any fee-for-service claims already settled and paid for dates of service impacted by the updated rates. The date of this EPC is still yet to be determined.
Also, as required by the Welfare and Institutions Code, Section 14184.201 (b) and (c), Medi-Cal MCPs operating in counties where long-term care services were carved in starting in January 2023 (non-county organized health system and non-coordinated care initiative counties) are required to reimburse network providers of long-term care at their facility-specific fee-for-service rates. Therefore, these plans are obligated to make payments both retroactively and prospectively based on these new rates and the applicable date of service.
