Long Term Care (LTC) Carve-In Intermediate Care Facility (ICF) and Subacute Implementation Go-Live on January 1, 2024
| Date: | November 14, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Providers and Facilities |
| Type: | Regulatory/Informational |
| Subject: | Long Term Care (LTC) Carve-In Intermediate Care Facility (ICF) and Subacute Implementation Go-Live on January 1, 2024 |
| Business: | Medi-Cal Managed Care |
By January 1, 2024, per the Department of Health Care Services (DHCS), all residents of ICF/DD, ICF/DD-H and ICF/DD-N Homes will transition from Fee-For-Service (FFS) Medi-Cal to Medi-Cal Managed Care. Additionally, Managed Care Plans (MCPs) must authorize and cover medically necessary adult and pediatric Subacute Care Services. HPSJ will be responsible for these LTC benefits. HPSJ will authorize and cover medically necessary services provided in these ICF homes and Subacute (both Pediatric and Adult) facilities. Included is the HPSJ’s ICF and Subacute webpage that includes important information about the implementation:
- Intermediate Care Facilities (ICF): https://www.hpsj.com/providers/intermediate-care-facilities/
- Sub-acute Services and Support: https://www.hpsj.com/providers/sub acute-services-and-support/ Additional information on the LTC Carve-In, can be found at the following links:
- https://www.dhcs.ca.gov/provgovpart/Pages/Intermediate-Care-Facility for-Developmentally-Disabled-ICF-DD-Long-Term-Care-Carve-In.aspx
- https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM-Subacute-Care Facility-Long-Term-Care-Carve-In.aspx
Please note Effective January 1, 2024, Medi-Cal Managed Care Plans in all counties must ensure that members in need of adult or pediatric subacute care services are placed in a health care facility that is under contract for subacute care with DHCS Subacute Contracting Unit (SCU) or is actively in the process of applying for a contract with SCU. Facilities must submit an application to SCU by December 15, 2023. Please Visit https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM-Subacute-Care-Facility-Long-Term Care-Carve-In.aspx for more information.
We thank you for ensuring that HPSJ members have access to after-hours care. If you have any questions, you may request to speak to a Provider Services Representative.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/