Medi-Cal Subacute Care Contracting Application Information for Facilities
| Date: | November 14, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Providers, Skilled Nurse Facilities (SNF), and Long-Term Care Facilities (LTC) |
| Type: | Regulatory |
| Subject: | Medi-Cal Subacute Care Contracting Application Information for Facilities |
| Business: | Medi-Cal Managed Care |
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 the California Department of Health Care Services (DHCS) Subacute Contracting Unit (SCU) or is actively in the process of applying for a contract with SCU.
In order to receive Medi-Cal subacute care reimbursement, a provider must be contracted with DHCS as per CCR, title 22, section 51215.6 (a) which states “Adult subacute services and pediatric subacute services shall be provided by a licensed general acute care hospital with distinct-part skilled nursing beds or a freestanding certified nursing facility that enters into a contract with the Department.” This requirement ensures that facilities receiving Medi-Cal subacute care reimbursement meet certain standards and that members residing in these facilities do not experience disruptions in access to care.
In order for facilities to receive Medi-Cal reimbursement, they must have a Subacute Care Program contract with DHCS SCU. Facilities must submit an application to SCU by December 15, 2023. The list of the currently contracted providers is available on the Medi-Cal Subacute website:
https://www.dhcs.ca.gov/services/medical/Pages/Subacute.aspx.
If your facility is already contracted with DHCS SCU, you do not need to do anything at this time. If your facility is not contracted with DHCS’ SCU, please contact Subacute2@dhcs.ca.gov as soon as possible to request an application. For more information, please refer to the Medi-Cal Subacute Care Contracting: Application Information for Facilities Fact Sheet by following the provided link: https://www.dhcs.ca.gov/Documents/MCQMD/Subacute-Contracting-Factsheet.pdf. Additional information on the Subacute Care Facility Carve-In can be found at https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM-Subacute-Care-Facility-Long-Term-Care-Carve-In.aspx.
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/