Medi-Cal: skilled nursing facility services.

Assembly Member Calderon's proposal to modify California's Medi-Cal Workforce and Quality Incentive Program would expand eligibility for performance-based payments to all skilled nursing facilities serving Medi-Cal beneficiaries, removing the current requirement that providers must belong to managed care networks. The legislation maintains the program's existing framework of performance metrics and directed payments while extending access to facilities outside established networks.

Under the amended program, payment calculations would apply retroactively to July 9, 2024, based on the total days of service provided to Medi-Cal beneficiaries, regardless of a facility's network status. The Department of Health Care Services would continue administering annual performance-based directed payments targeting $280 million for 2023, with subsequent years adjusted according to specified rate increases. The department would retain authority to establish payment methodologies and eligibility criteria in consultation with industry stakeholders, including requirements that facilities meet workforce-related performance metrics.

The bill preserves existing exemptions for freestanding pediatric subacute care facilities and special programs for mentally disordered patients. Payments would remain subject to federal approval under Medicaid managed care regulations and must maintain actuarially sound capitation rates. The legislation requires managed care plans to process retroactive payments for newly eligible facilities while ensuring directed payments supplement rather than replace standard reimbursement rates.