reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7.5 - HOSPITAL INPATIENT SERVICES REIMBURSEMENT SECTION › Section 51553 - Peer Grouping

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Hospital reimbursement shall, unless exempted from or modified by the
					 provisions of this section, be payable at no more than the 60th percentile
					 aligned ARPD of the peer group to which the hospital is assigned by the
					 Department. This limit is the Peer Group Rate Per Discharge Limitation
					 (PGRPDL). The peer groups shall be based on a classification of hospitals as
					 determined in the 1991 Hospital Peer Grouping Report published by the
					 Department, that combines individual hospitals in a unit on the basis of
					 similar or common characteristics. The following peer group classifications
					 will be used:
(1) University Teaching
					 Hospitals.
(2) Major
					 (non-university) Teaching Hospitals.
(3) Large Teaching Emphasis
					 Hospitals.
(4) Medium/Small
					 Teaching Emphasis Hospitals.
(5)
					 Extremely Large Sized Hospital.
(6)
					 Large Sized Hospitals.
(7)
					 Moderately Sized Hospitals.
(8)
					 Medium Sized Hospitals.
(9)
					 Moderately Small Sized Hospitals.
(10) Very Small Sized Hospitals.
(11) Acute Psychiatric Hospitals.
(12) Alcohol-Drug Rehabilitation
					 Hospitals.
(13) Combination
					 Psychiatric/Alcohol/Drug Rehabilitation Hospitals.
(14) Psychiatric Health Facilities.
(15) Psychiatric Teachering
					 Hospitals.
(16) Psychiatric
					 Children's Hospitals.
(17) Moderate
					 Alcohol-Drug Rehabilitation Emphasis Hospitals.
(18) Moderate Psychiatric Emphasis
					 Hospitals.
(19) State
					 Hospital-Veterans Home.
(20) State
					 Hospital-Mental Health.
(21) State
					 Hospital-Developmental Services.
(22) Children's Hospitals.
(23) Crippled Children's Hospitals.
(24) Rehabilitation Hospitals.
(25) Large Rehabilitation Emphasis
					 Hospitals.
(26) Respiratory
					 Specialty Hospitals.
(27) Student
					 Health Centers.
(28) Charitable
					 Research Hospitals.
(29) Rural
					 Hospitals.
(30) Specialty Teaching
					 Hospitals.
(31) Prepaid Health Plan
					 Hospitals.
(32) Prepaid Health
					 Plan-Psychiatric/Alcohol-Drug Rehabilitation Hospitals.
(33) Prepaid Health Plan-Teaching
					 Emphasis.
(34) Eye
					 Hospitals.
(35) Women
					 Hospitals.
(36) Dental/Outpatient
					 Hospitals.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7.5 - HOSPITAL INPATIENT SERVICES REIMBURSEMENT SECTION › Section 51554 - Peer Group Administrative Adjustments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A provider may request an AA of the
					 reimbursement limits specified in this section and their peer group placement
					 at the time of tentative and final PIRL settlement.
(1) The request shall be made within 90 days
					 after notification of the reimbursement limits and shall be made in accordance
					 with the procedures specified in Section
					 51550.
(2) The burden of proof shall be on the
					 provider to prove that the additional reimbursement sought meets all of the
					 requirements under Section
					 51550 and that except where a
					 specific formula in Section
					 51555 exists, the provider's cost
					 per discharge of the item being appealed, exceeds the 60th percentile cost per
					 discharge of the item being appealed.
(3) In addition to the items listed under
					 Section 51550(b), the
					 following items shall not be subject to an AA of the PGRPDL:
(A) The use of hospital peer
					 groups.
(B) The use of 60th
					 percentiles and the methods used to compute them.
(C) Changes in case mix.
(D) Costs associated with strikes, other
					 labor stoppages or slow downs.
(E)
					 The addition of new services.
(F)
					 Costs due to low occupancy.
(G)
					 Difference in the type, nature, or scope of items or services available whether
					 or not provided, between the provider and other providers in its peer group
					 since differences in the actual services needed to be rendered are accounted
					 for in the CMA as specified in Section
					 51555.
(H) Any other issue that is not a difference
					 between the provider and other providers in their peer
					 group.
(4) A provider may
					 appeal the Department's decision on the AA for final PIRL settlements only. The
					 appeal shall be in accordance with Section
					 51552.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7.5 - HOSPITAL INPATIENT SERVICES REIMBURSEMENT SECTION › Section 51556 - Contracts

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1) The reimbursement limitation for the
					 noncontract service costs of contracting hospitals which had a valid contract
					 during the entire settlement fiscal period shall be determined by the following
					 method:
Noncontract Reduction = NMCN - TCL
Where:
NMCN = Noncontract Medi-Cal net cost of covered services
						including third-party liability amounts
TCL = PYNCPD * PDL * SYND
PYNCPD = PYNC/PYND
TCL = Total cost limit exclusive of any reductions for
						third-party liability
PYNCPD = Prior fiscal period noncontract cost per
						day
PYNC = Prior fiscal period noncontract costs
PYND = Prior fiscal period noncontract days
PDL = Per diem limit increase which shall be the target
						as specified in federal regulation CFR 42, Section
						413.40(c)(3).
SYND = Settlement fiscal period noncontract
						days
(2) All AA and appeal
					 issues must pertain to the reason for the increase in the average noncontract
					 costs per day from the prior fiscal period to the settlement fiscal
					 period.
(3) Contracting hospitals
					 with noncontract service costs will also have an ARPDL calculation performed
					 each FPE. The calculation will be used to determine the base period for the
					 next FPE in the event the provider discontinues the contracting
					 program.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7.5 - HOSPITAL INPATIENT SERVICES REIMBURSEMENT SECTION › Section 51557 - Disproportionate Share

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Disproportionate share payments shall be paid in
						accordance with the provisions of the State Plan.
1. New
						section filed 4-23-92; operative 5-25-92 (Register 92, No.
						20).
Note: Authority cited: Sections
						  10725,
						  14100.1,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14100.1
						  and
						  14105,
						  Welfare and Institutions Code; and Chapter 976, Statutes of 1988 (AB
						  2563).
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 8 - CONFLICT OF INTEREST › Section 51600 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The following
					 definitions shall govern the interpretation of this article unless the context
					 or subject matter otherwise requires:
(1)
					 "State or local officer or employee who is responsible for the expenditure of
					 substantial amounts of funds under Medi-Cal" means a person holding any of the
					 following positions, or the functional equivalents thereof, on or after
					 September 26, 1980:
(A) Governor's Office
1. Special Hospital
					 Negotiator
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 8 - CONFLICT OF INTEREST › Section 51601 - Exclusion from Proceedings

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Any act prohibited under the provisions of Sections
					 207 or
					 208, Title 18, United States Code,
					 shall also be prohibited under this Article when committed in connection with
					 Medi-Cal by a:
(1) Current or former State or
					 local officer or employee responsible for expenditure of substantial amounts of
					 Medi-Cal funds.
(2) Partner of a
					 person in (1).
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 8 - CONFLICT OF INTEREST › Section 51602 - Prohibition Against Contracting

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department shall not approve, renew,
					 or continue a fiscal intermediary contract if any current employee of the
					 contractor, or a subcontractor to the contractor, was all of the following:
(1) In State employment on or after September
					 26, 1980.
(2) A fiscal intermediary
					 management employee within two years prior to terminating State
					 employment.
(3) Employed by the
					 contractor, or a subcontractor to the contractor, within one year after
					 terminating State employment.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52000 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following definitions shall apply only to Chapter 3.
						Article 9.
(a) "Administrator
					 Compensation" means the remuneration paid to a facility administrator
					 regardless of the form in which it is paid. "Administrator Compensation"
					 includes salary, wages, fringe benefits, allowances, bonuses, debt forgiveness,
					 severance payments, payments for accumulated but unused leave and payments of
					 amounts previously deferred. "Administrator Compensation" includes fees
					 regardless of the label placed on them, for example, consultant fees or
					 director's fees.
(b)
					 "Administrative Costs" means
1) expenses
					 including the facility's portion of home office costs related to the overall
					 management and administration of the facility, including those of the medical
					 director, general and patient accounting activities, communication systems,
					 data processing activities, patient admissions, governing board activities,
					 public relations, paid liability losses, theft insurance, auto insurance,
					 property insurance, licenses and taxes (other than property and income taxes
					 and facility license fee),
2) taxes
					 related to liability insurance,
3)
					 the production of indexes, abstracts, and statistics for facility management
					 uses,
4) procuring supplies,
					 equipment and service necessary to facility operations, and
5) interest incurred on borrowing other than
					 interest incurred on mortgage notes, capitalized lease obligations and other
					 borrowing for the acquisition of land, buildings and
					 equipment.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52100 - Quality Assurance Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each rate year, Freestanding Nursing
					 Facility, Level-Bs (FS/NF-Bs) and Freestanding Subacute Nursing Facility,
					 Level-Bs (FSSA/NF-Bs) shall pay a uniform Quality Assurance Fee (QAF) pursuant
					 to Health and Safety Code Section
					 1324.21,
					 as described in Sections
					 52100 through
					 52104. The QAF shall not exceed
					 the percentage set forth in Title 42, United States Code Section
					 1396 b(w)(4)(C)(ii).
(b) Each FS/NF-B and FSSA/NF-B shall
					 determine the amount due, as specified in Health and Safety Code Section
					 1324.21(b),
					 by multiplying the QAF by the total resident days for the preceding
					 month.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency,
						including amendment of subsection (b); operative 1-18-2011 (Register 2011, No.
						2). A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
3. Certificate of Compliance as to 1-10-2011 order
						transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14105
						  and
						  14110.6,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52101 - Payment of the Quality Assurance Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each FS/NF-B and FSSA/NF-B shall remit
					 payment of the amount due to the Department on a monthly basis on or before the
					 last day of the month following the month in which the QAF is imposed, with a
					 completed Freestanding Nursing Facility, Level-B (FS/NF-B) and Freestanding
					 Subacute Nursing Facility, Level-B (FSSA/NF-B) Quality Assurance Fee Payment
					 Invoice form DHCS 9116 (Rev. 03-10), herein incorporated by reference in its
					 entirety.
(b) If a FS/NF-B or
					 FSSA/NF-B fails to pay all or part of the amount due within 60 calendar days of
					 the date the payment is due, as specified in subsection (a), the Department
					 shall issue a delinquency notice to the FS/NF-B or FSSA/NF-B demanding payment
					 within 15 calendar days of the date of the delinquency notice.
(c) Each FS/NF-B and FSSA/NF-B shall be
					 liable for payment of interest at the rate of seven percent per annum on any
					 unpaid amount due, beginning on the 61st calendar day from the date the payment
					 is due, until the unpaid amount due, plus any interest, is paid in
					 full.
(d) If a FS/NF-B or FSSA/NF-B
					 fails to pay all or part of the outstanding amount due, the Department shall
					 recover the unpaid amount due, plus interest, by one or more of the following
					 methods, until paid in full:
(1) Offset any
					 Medi-Cal reimbursement payments due to the FS/NF-B or FSSA/NF-B;
(2) Execute a repayment agreement between the
					 FS/NF-B or FSSA/NF-B and the Department;
(3) Assess a penalty up to 50 percent of the
					 unpaid amount due;
(4) Recommend to
					 the California Department of Public Health that license renewal be delayed
					 until the Department has recovered the full amount due.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52102 - Exemption from the Quality Assurance Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Facilities specified in Health and Safety Code Section
						1324.20(c),
						are exempt from payment of the QAF, as specified in Section
						52101.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency,
						including repealer of subsection (a) designator and subsections (b) and (c);
						operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14105
						  and
						  14110.6,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52103 - Request for Exemption from the Quality Assurance Fee. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register 2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. Readoption of 7-22-2010 emergency filing, including
						repealer of section filed 1-10-2011; operative 1-18-2011 (Register 2011, No.
						2). A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
3. Repealed 4-19-2011 by operation of law upon
						expiration of 1-10-2011 emergency repeal by operation of Government Code
						section
						11366.1(g)
						(Register
						2011,
						No. 20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14105
						  and
						  14110.6,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52104 - Quality Assurance Fee and Change of Ownership

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The amount due shall be assessed on each FS/NF-B and
						FSSA/NF-B irrespective of any change in ownership, change in ownership interest
						or control, or the transfer of any portion of the assets of a FS/NF-B and
						FSSA/NF-B to another owner. A new owner shall assume any and all liability for
						payment of the amount due, plus interest, owed by the
						facility.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency;
						operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14105
						  and
						  14110.6,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52500 - Facilities Subject to Facility-Specific Rate Setting System

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Facilities
					 subject to the reimbursement methodology, as described in Sections
					 52500 through
					 52516, and as authorized by
					 Welfare and Institutions Code Section
					 14126
					 shall be Freestanding Nursing Facility, Level-Bs (FS/NF-B), and Freestanding
					 Subacute Nursing Facility, Level-Bs (FSSA/NF-B).
(b) The per diem rate shall be calculated
					 prospectively on a facility-specific basis using facility-specific audited cost
					 report data as specified in Health and Safety Code Section
					 128730.
(1) Cost report data shall be submitted in
					 accordance with Title 22, California Code of Regulations Section
					 97040.
(2) Audited cost report data shall be used
					 for facility-specific rate setting.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52501 - Facility Specific Rate Methodology

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The facility-specific cost-based per diem payment shall
						be based on the sum of the projected costs of the cost categories listed below.
						Costs within a specific cost category shall not be shifted to any other cost
						category. The cost categories are as follows:
(a) Labor costs
(b) Direct and Indirect care non-labor
					 costs
(c) Administrative
					 costs
(d) Capital costs
(e) Direct pass-through costs
(f) Professional liability insurance
					 costs
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency,
						including amendment of first paragraph and new subsection (f); operative
						1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52502 - Labor Costs Category

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Labor costs shall be calculated by combining direct care labor costs, direct
					 care agency costs, indirect care labor costs, and indirect care agency
					 costs.
(b) The Department shall
					 calculate the daily direct care labor costs by combining direct care labor
					 costs and direct care agency costs and dividing by total resident days.
(1) The benchmark for the daily direct care
					 labor cost rate component shall be the 90th percentile of each peer
					 group.
(2) The Department shall
					 determine the rate component for each facility either at actual inflated cost
					 or the benchmark for its peer group, whichever is lower.
(3) Each facility's direct care labor costs
					 shall be adjusted by the labor inflation index from the mid-point of the cost
					 reporting period to the mid-point of the rate year.
(4) If a FSSA/NF-B enters into service
					 agreements with unrelated contractors to operate physical therapy, speech
					 pathology, occupational therapy, or respiratory therapy services, the
					 contractor's documented cost of labor to work within the facility shall be
					 included as direct care agency costs. If the facility does not submit to the
					 Department the unrelated contractor's supporting documentation of the
					 contractor's labor costs, all of the purchased service costs shall be included
					 in other non-labor. If the consultant is employed by a related entity, the cost
					 is treated as if it was incurred by the facility.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52503 - Direct and Indirect Care Non-Labor Costs Category

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department shall calculate the daily direct and
						indirect care non-labor costs by dividing direct and indirect care non-labor
						costs by total resident days.
(a) The
					 benchmark for the daily direct and indirect care non-labor cost rate component
					 shall be the 75th percentile of each peer group.
(b) The Department shall determine the rate
					 component for each facility either at actual inflated cost or the benchmark for
					 its peer group, whichever is lower.
(c) Each facility's direct and indirect care
					 non-labor costs shall be adjusted by the California Consumer Price Index for
					 All-Urban Consumers from the mid-point of the cost reporting period to the
					 mid-point of the rate year.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency,
						including amendment of section heading and section; operative 1-18-2011
						(Register 2011, No. 2). A Certificate of Compliance must be transmitted to OAL
						by 4-18-2011 or emergency language will be repealed by operation of law on the
						following day. Any rules issued by provider bulletin by the Department of
						Health Care Services that are covered by or inconsistent with these emergency
						regulations are superseded as of the effective date of these emergency
						regulations.
3. Certificate of Compliance as to 1-10-2011 order,
						including amendment of section, transmitted to OAL 4-5-2011 and filed 5-17-2011
						(Register 2011, No. 20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52504 - Administrative Costs Category

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department shall calculate the daily administrative
						costs by dividing administrative costs by total resident days.
(a) The benchmark for the daily
					 administrative cost rate component shall be the 50th percentile of each peer
					 group.
(b) The Department shall
					 determine the rate component for each facility either at actual inflated cost
					 or the benchmark for its peer group, whichever is lower.
(c) Each facility's administrative costs
					 shall be adjusted by the California Consumer Price Index for All-Urban
					 Consumers from the mid-point of the cost reporting period to the mid-point of
					 the rate year.
(d) Administrator
					 compensation for services, provided by sole proprietors, partners, officers,
					 directors or other administrators of skilled nursing facilities defined in
					 Health and Safety Code Section
					 1250(c),
					 shall be limited to:
(1) The reasonable value
					 of the services performed regardless of the type of service.
(2) Compensation essential to employ a staff
					 person, in place of the administrator, in order to maintain the daily
					 operations of the facility administrator.
(3) The value of comparable services provided
					 at a similar facility, based on the size and classification of the facility,
					 geographic location, the number and type of personnel supervised, the
					 qualifications of the administrator and duties performed.
(4) The value of services rendered in
					 connection with resident care as determined by arm's length
					 transactions.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52506 - Direct Pass-Through Costs Category

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1)
					 Direct pass-through costs are comprised of proportional Medi-Cal costs for
					 property taxes, facility license fees, caregiver training costs, the Medi-Cal
					 portion of the facility quality assurance fee, and new state and federal
					 mandates for the applicable rate year.
(2) The Medi-Cal proportional share of the
					 pass-through per diem costs shall be calculated as the facility actual
					 allowable Medi-Cal cost as reported on the facility's most recent available
					 cost report, as adjusted for audit findings.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52507 - Professional Liability Insurance Costs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department shall calculate costs for
					 professional liability insurance by dividing professional liability insurance
					 costs by total resident days.
(b)
					 The benchmark for the professional liability insurance cost rate component,
					 including insurance deductible costs, shall be the 75th percentile of each peer
					 group.
(c) Facilities shall report
					 supplemental data on an annual basis as specified under 52500(b), otherwise
					 insurance deductible costs shall continue to be reimbursed within the
					 administrative costs category.
(d)
					 The Department shall determine the rate component for each facility either at
					 actual inflated cost or the benchmark for its peer group, whichever is
					 lower.
(e) Each facility's
					 professional liability insurance costs shall be adjusted by the California
					 Consumer Price Index for All-Urban Consumers from the mid-point of the cost
					 reporting period to the mid-point of the rate year.
1. New
						section filed 1-10-2011 as an emergency; operative 1-18-2011 (Register
						2011,
						No. 2). A Certificate of Compliance must be transmitted to OAL by 7-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. Certificate of Compliance as to 1-10-2011 order,
						including amendment of section and NOTE, transmitted to OAL 4-5-2011 and filed
						5-17-2011 (Register 2011, No. 20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14132,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52508 - Peer-Groups

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department
					 shall place FS/NF-Bs in each county in the following peer groups:
Peer Group
								Number
County
1
Colusa
Del Norte
Imperial
Kern
Kings
Lake
Lassen
Tulare
Yuba
2
Butte
Humboldt
Inyo
Madera
Mendocino
Merced
San Luis Obispo
Tehama
Yolo
3
Calaveras
Glenn
Plumas
San Joaquin
Shasta
Siskiyou
Stanislaus
Sutter
Ventura
4
Amador
El Dorado
Nevada
Placer
Tuolumne
5
Los Angeles
6
Fresno
Orange
Riverside
San Bernardino
San Diego
Santa Cruz
Solano
7
Alameda
Contra Costa
Marin
Monterey
Napa
Sacramento
San Francisco
San Mateo
Santa Barbara
Santa Clara
Sonoma
(b) FSSA/NF-Bs shall be in their own peer
					 group.
(c) The seven counties in
					 California that have no Medi-Cal skilled nursing days shall be excluded from
					 the peer groups identified in subsection (a).
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency;
						operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52509 - Rate-Setting for State-Owned Facilities (FS/NF-Bs)

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
State-owned and operated FS/NF-Bs shall receive a
						prospective payment rate based on the peer-group weighted average Medi-Cal
						reimbursement rate.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency;
						operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52510 - Rate-Setting for Newly Certified Facilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Facilities newly certified to participate
					 in the Medi-Cal program, shall receive a reimbursement rate based on the
					 peer-group weighted average Medi-Cal reimbursement rate. Facilities shall
					 continue to receive the peer-group weighted average Medi-Cal reimbursement rate
					 until one of the conditions of subsection (b)(1) or (b)(2) has been
					 met.
(b)
(1) The Department shall calculate the
					 FS/NF-B facility-specific rate when a minimum of six months of Medi-Cal cost
					 data has been audited. The facility-specific rate shall be calculated
					 prospectively and shall be effective on August 1 of each rate year, pursuant to
					 Welfare and Institutions Code Section
					 14126.021.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52511 - Rate-Setting for De-Certified Facilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Facilities that have been de-certified
					 for less than six months and upon recertification shall continue to receive the
					 facility per diem reimbursement rate in effect prior to decertification.
					 Facilities shall continue to receive the facility per diem reimbursement rate
					 until one of the conditions in paragraph (1) or (2) have been met.
(1) The Department shall calculate the
					 FS/NF-B facility-specific rate when a minimum of six months of Medi-Cal cost
					 data has been audited. The facility-specific rate based on the audited six
					 months of Medi-Cal cost data shall be calculated prospectively and shall be
					 effective on August 1 of each rate year, pursuant to Welfare and Institutions
					 Code Section
					 14126.021.
(2) The Department shall calculate the
					 FSSA/NF-Bs facility-specific rate when a cost report with a minimum of twelve
					 months of Medi-Cal cost data has been audited. The facility-specific rate shall
					 be calculated prospectively and shall be effective on August 1 of each rate
					 year, pursuant to Welfare and Institutions Code Section
					 14126.021.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52512 - Rate-Setting for Facilities with Changes of Ownership

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Facilities that have a change of
					 ownership or changes of the licensed operator shall continue to receive the
					 facility per diem reimbursement rate in effect with the previous owner.
					 Facilities shall continue to receive the facility per diem reimbursement rate
					 until one of the conditions in subsection (b)(1) or (b)(2) have been
					 met.
(b)
(1) The Department shall calculate the
					 FS/NF-B facility-specific rate when a minimum of six months of Medi-Cal cost
					 data has been audited. The facility-specific rate shall be calculated
					 prospectively and shall be effective on August 1 of each rate year, pursuant to
					 Welfare and Institutions Code Section
					 14126.021.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52513 - Change in Facility Fiscal Period

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except for changes in ownership, when a facility files
						more than two Office of Statewide Health Planning and Development reports in a
						calendar year, the Department shall use the most recent facility fiscal period
						available.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency;
						operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be
						transmitted to OAL by 4-18-2011 or emergency language will be repealed by
						operation of law on the following day. Any rules issued by provider bulletin by
						the Department of Health Care Services that are covered by or inconsistent with
						these emergency regulations are superseded as of the effective date of these
						emergency regulations.
3. Certificate of Compliance as to 1-10-2011
						order transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No.
						20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5
						  and
						  14126.027,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.