Section 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.Cal. Code Regs. Tit. 22, § 52511
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 A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or emergency language will be repealed by operation of law on the following day.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.
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).