SNF WQIP Bed Days

SNF WQIP (Skilled Nursing Facility Workforce and Quality Incentive Program) qualifying bed days are calendar days during which a Member receives SNF Level-B services inclusive of the first day of a Member’s stay and excluding the day of discharge unless it is also the first day of stay, rendered during the PY and billed under a Network Provider Agreement with an MCP pursuant to applicable state and federal laws, regulations, and contractual terms for which Medi-Cal is the primary payer and where Medicare is no longer covering any portion of the bed day. SNF Level-B services are defined in California Code of Regulations (CCR) sections 51123(a), 51511(b), 51535, and 51535.1 as applicable and include:

• SNF services as set forth in 22 CCR section 51123(a):
  • Room and board.
  • Nursing and related care services.
  • Commonly used items of equipment, supplies, and services as set forth in 22 CCR section 51511(b).
• Leave-of absence days as set forth in 22 CCR section 51535.
• Bed holds as set forth in 22 CCR section 51535.1.

Pursuant to W&I section 14126.024(e), bed days receiving reimbursement for special treatment program (STP) services for the mentally disordered are not qualified for SNF WQIP payments. Furthermore, hospice bed days are not qualified for SNF WQIP. Facilities in which all beds are designated for STP and/or hospice services thus are not qualified for SNF WQIP.

Bed days reimbursed outside of a Network Provider Agreement, bed days for which Medi-Cal is a secondary payer, and bed days reimbursed through the Medi-Cal FFS delivery system are not qualified for SNF WQIP.

SNF WQIP payments will be made by MCPs to SNF WQIP-eligible Network Providers based on an interim and final per diem amount calculated by the Department of Health Care Services (DHCS) in accordance with the preprint approved by the Centers for Medicare & Medicaid Services (CMS) and DHCS’ SNF WQIP Technical Program Guide.5 For each PY, DHCS will aim to calculate quality scores and provide payment exhibits directing MCPs to pay the interim per diem amount during the first part of the CY following the Rating Period, and the final per diem amount during the second part of the CY following the Rating Period.

MCPs are responsible for calculating the number of SNF WQIP qualifying bed days and paying the directed per diem amount for all Clean Claims for SNF WQIP qualifying bed days without regard to when these bed days are reported to DHCS, consistent with any reporting requirements applicable to the SNF.

MCPs are responsible for netting out any previously directed interim payment amounts from the final payment. MCPs are responsible for recouping or withholding any amounts related to Class AA or A citations from interim and final payments.

MCPs must make payments to SNF WQIP-eligible Network Providers for qualifying bed days within 45 calendar days of receiving payment exhibits from DHCS or within 30 calendar days of receiving a Clean Claim from the Provider, whichever is later. MCPs must designate that payment is for the SNF WQIP (including the PY) when sending payment to SNF Providers.

View the SNF WQIP Payment Report by year:

In accordance with SNF WQIP’s requirements, MCPs must withhold SNF WQIP payments for facilities with one or more Class AA or A citations issued by the California Department of Public Health (CDPH) for violations that occur wholly or in part during the PY.

•  Class AA citations are issued to facilities for actions that are the proximate cause of resident death. Facilities with one or more class AA citations partly or wholly in the PY are disqualified from payments for that PY.
  • Class A citations are issued to facilities for actions where there is imminent danger of death or serious harm to a resident or a substantial probability of death or serious physical harm. Facilities with one or more class A citations partly or wholly in the PY receive a 40 percent penalty in addition to the per diem payment amount for that PY.