Nursing Facility Financing Reform (AB 186)
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Assembly Bill 186 (Chapter 46, Statutes of 2022) amended the Medi-Cal Long-Term Care Reimbursement Act to reform the financing methodology applicable to Freestanding Skilled Nursing Facilitates Level-B and Adult Freestanding Subacute Facilities Level-B. The financing methodology authorized by AB 186 is effective January 1, 2023 through December 31, 2026. AB 186 authorizes DHCS to implement three major new programs: Workforce & Quality Incentive Program (WQIP), Workforce Standards Program, and Accountability Sanctions Program. DHCS is developing these programs in 2022 and 2023.
The reforms authorized by AB 186 are intended to:
- Better incentivize and hold facilities accountable for quality patient care.
- Emphasize the critical role of workforce.
- Better balance distribution of annual rate increases.
- Result in the long-term financial viability of facilities in the Medi-Cal managed care environment.
Program Components
Program Component
| Development Timeline
| Implementation Timeline
|
Workforce & Quality Incentive Program (WQIP). DHCS will provide directed payments to facilities to incentivize workforce and quality. This program succeeds the former Quality and Accountability Supplemental Payment (QASP) program.
| September 2022 - December 2022
| Payments made to facilities in early 2024 based on Calendar Year (CY) 2023 utilization.
|
Workforce Standards Program. DHCS will establish workforce standards such as maintain a collective bargaining agreement or paying prevailing wage. DHCS will provide facilities that meet these standards with a workforce augmentation to base their per diem rate effective for CY 2024.
| December 2022 - June 2023
| Rate augmentation effective for CY 2024.
Facility reporting required in mid-2023.
|
Accountability Sanctions Program. DHCS is authorized to sanction facilities that do not meet quality standards established by DHCS on a per Medi-Cal bed basis.
| July 2023 - November 2023
| Quality standards will be effective for CY 2024.
|
Stakeholder Consultation
AB 186 requires Department of Health Care Services (DHCS) to establish the methodology, parameters, and eligibility criteria for these programs in consultation with representatives from the long-term care industry, organized labor, consumer advocates, and managed care plans. DHCS is continuing to research and refine the program design and welcomes stakeholder input. Please submit any written comments to AB186Comments@dhcs.ca.gov.
Stakeholder Meetings
DHCS has scheduled stakeholder meetings in 2023 that will be conducted as online webinars. DHCS will update this webpage with meeting materials and information on how to join upcoming webinars.
Nursing Facility Financing Reform Webinar
On April 12, 2023 from 3:00 p.m. to 4:00 p.m., DHCS will host a virtual stakeholder webinar discussing the development of the Workforce Standards Program and presenting an update on the Workforce and Quality Incentive Program (WQIP), authorized by
Assembly Bill 186 (Chapter 46, Statutes of 2022). This meeting will also provide an opportunity for stakeholder input.
Webinar registration is now open. Please follow this registration link for the upcoming webinar on April 12, 2023.
Upcoming Meetings:
Past Meetings:
Accessibility:
For individuals with disabilities, DHCS will provide free assistive devices, including language and sign-language interpretation, real-time captioning, note takers, reading or writing assistance, and conversion of training or meeting materials into braille, large print, audio, or electronic format. To request alternative format or language services, please call or write:
Department of Health Care Services
Fee-For-Service Rates Development Division
1501 Capitol Avenue, MS 4600
P.O. Box 997417
Sacramento, CA 95899-7417
(916) 552-9600
Please note that the range of assistive services available may be limited if requests are received less than ten working days prior to the meeting or event.
