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HSC 3010 Assignment Long Term Care Reimbursement

HSC 3010 Assignment Long Term Care Reimbursement

 

An overview of the different Medicare and Medicaid services.

The population covered under Medicare and Medicaid services.

The services of long-term care covered under Medicare and Medicaid, including the restrictions placed on them.

The Long Term Care (LTC) Reimbursement Unit conducts the annual study to develop the Medi-Cal rates for a variety of long-term care providers. This study serves as the basis for Medi-Cal reimbursements of Nursing Facilities including Nursing Facility – Level A (NF-A), Distinct Part Skilled Nursing Facilities of General Acute Care Hospitals (DP/NF-Bs), Distinct Part Adult Subacute Units for General Acute Care Hospitals (DP/ASA), Hospice Care, Rural Swing Beds, Acute and Transitional Inpatient Care Administrative Days (Administrative Days Level 1) and Intermediate Care Facilities for the Developmentally Disabled
(ICF-DD) (including ICF/DD-Habilitative and ICF/DD-Nursing). This unit also conducts the necessary research to develop new or revised reimbursement methodologies necessary to meet changing policy or program needs.

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The Medi-Cal LTC reimbursement rates are established under the authority of Title XIX of the federal Social Security Act. The specific methodology is described in the State Plan, a document prepared by the Department staff which requires approval by the Centers for Medicare and Medicaid Services (CMS). 

Effective for dates of service on or after August 1, 2018, the Department of Health Care Services (DHCS) will reimburse hospice providers for fee-for-service room and board services at 95 percent of the total per diem reimbursement, which will include the 2018 – 2019 facility per diem rate plus the supplemental payment per diem amount authorized by SPA 18-0029, for patients residing in an ICF/DD facility.

  • The additional reimbursement will be paid on a qThe services of long-term care covered under Medicare and Medicaid, including the restrictions placed on them.uarterly basis, beginning on December 2018, for hospice room and board service bed days rendered in the immediately preceding quarter, beginning with the quarter spanning August 1, 2018, through October 31, 2018.
  • The additional quarterly reimbursements will be paid through warrants issued by the State Controller’s Office and will be paid separately and in addition to the usual hospice room and board reimbursements paid through the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary.
  • The additional reimbursement is subject to the availability of funds. 

Claims submitted with Revenue Code 0658 for fee-for-service room and board services for patients residing in ICF/DDs will receive the additional reimbursement. Hospice providers should continue to bill as usual. No additional action is required of providers. DHCS may contact affected providers for additional information if needed to process reimbursements.

The Hospice Room and Board Additional Reimbursement per diem amounts are as follows. Note that facilities in peer groups in which the unfrozen 2017-18 65th percentile rate is lower than the current reimbursement rate will not receive the additional reimbursement. 

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