Cal. Code Regs. Tit. 22, § 52511 - Rate-Setting for De-Certified Facilities
(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.
(b) Facilities that have been de-certified
for six months or longer and upon recertification 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 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 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.
Notes
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 A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or emergency language will be repealed by operation of law on the following day.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.
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).
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