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​​​​​​​​​​​​​Intermediate Care Facilities - Developmentally Disabled​, Habilitative​​, Nurs​ing

Reimbursement rates for Intermediate Care Facilities, Developmentally Disabled (ICF/DD), Habilitative (ICF/DD-H), and Nursing (ICF/DD-N) are updated annually using an unfrozen, peer-grouped, cost-based rate methodology in accordance with Attachment 4.19-D of the California Medicaid State Plan. Facilities are classified into peer groups by level of care and bed size. The reimbursement rates for each peer group are established at the 65th percentile of the group's projected costs based on the most recent reported and audited cost data adjusted for inflation, plus the projected cost of complying with new state or federal mandates (such as state minimum wage increases) and the Quality Assurance Fee (QAF). Effective August 1, 2022, the former Proposition 56 Supplemental Payments have transitioned to be included as part of the unfrozen, cost-based rate.

In response to the increased cost pressures incurred by facilities due to the COVID-19 Public Health Emergency (PHE), DHCS is providing these facilities with a COVID-19 PHE temporary rate increase equal to 10 percent of their 2019-20 per diem rates for the duration of the PHE, as approved in State Plan Amendment 20-0024. 

In accordance with Senate Bill 184 (Chapter 47, Statutes of 2022), which amended Welfare and Institutions Code § 14105.075, DHCS is establishing a hold harmless provision for dates of service after the declared end of the PHE in the approved State Plan Amendment 22-0061​. The hold harmless provision will provide that after the last day of the PHE, facilities will receive the greater of:

  • The unfrozen, cost-based rate as described above, or
  • The total reimbursement rate in effect on the last day of the PHE, inclusive of the COVID-19 PHE temporary rate increase.​

There are no changes to the billing process. For claims billed with dates of service between August 1, 2022 and July 31, 2023, providers should immediately begin to bill the updated 2022-23 rates. DHCS is working to install the updated rates in the fiscal intermediary billing system. Pending installation of the 2022-23 rates, providers will be reimbursed the 2021-22 rate. Retroactive payment adjustments will automatically be made as necessary by the fiscal intermediary through an Erroneous Payment Correction (EPC). No additional action will be necessary on the providers' part. ​​

Rates​

​2022-23 ICF/DD Rates - Effective August 1, 2022

​
Facility Type
​Regular
Accommodation
Code
​Total
Reimbursement
Per Diem
​Bed Hold
Accommodation
Code
​​Total Bed Hold
Reimbursement
Per Diem
​ICF/DD 1-59 Beds
​41
​$369.73
​43
​$360.27​
​ICF/DD 60+ Beds
​41
​$388.37
​43
​$378.91
​ICF/DD-H 4-6 Beds
​61
​$357.69
​63
​$348.23
​ICF/DD-H 7-15 Beds
​65
​$371.78
​68
​$362.32
​ICF/DD-N 4-6 Beds
​62
​$394.48
​64
​$385.02
​ICF/DD-N 7-15 Beds
​66
​$445.65
​69
​$436.19

Notes:

  • Total Reimbursement Per Diem rate includes the temporary COVID-19 PHE rate increase and add-ons for the projected cost of complying with the January 1, 2023 state minimum wage increase, and the quality assurance fee.
  • Please see the Department of Industrial Relation's minimum wage website for more information on California minimum wage laws.
  • The 2022-23 bed hold amount is $9.46
  • Managed Care organizations may refer to the Total Reimbursement and the Total Bed Hold Reimbursement amounts.

​2021-22 ICF/DD Rates - Effective August 1, 2021



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Last modified date: 12/21/2022 3:25 PM