Legal Resources | | T22 51510.1
Subdivision 1. California Medical Assistance Program. Chapter 3. Health Care Services. Article 7. Payment for Services and Supplies (Refs & Annos). Intermediate Care Services for the Developmentally Disabled
(a) Each provider of intermediate care services for the developmentally disabled shall furnish all equipment, drugs, services and supplies necessary to provide intermediate care services for the developmentally disabled except as provided in subsection (b). Such equipment, drugs, supplies, and services are, at a minimum, those which are required by law, including those required by federal Medicaid regulations and state licensing regulations.
(b) Not included in the payment rate and to be billed separately by the provider thereof, subject to the utilization controls and limitations of Medi-Cal regulations covering such services and supplies, are as follows:
(1) Allied health services ordered by the attending physician.
(2) Alternating pressure mattresses/pads with motor.
(3) Atmospheric oxygen concentrators and enrichers and accessories.
(4) Blood, plasma and substitutes.
(5) Dental services.
(6) Durable medical equipment as specified in Section 51321(g).
(7) Insulin.
(8) Intermittent positive pressure breathing equipment.
(9) Intravenous trays, tubing and blood infusion sets.
(10) Laboratory services.
(11) Legend drugs.
(12) Liquid oxygen system.
(13) MacLaren or Pogon Buggy.
(14) Medical supplies as specified in the list established by the Department.
(15) Nasal cannula.
(16) Osteogenesis stimulator device.
(17) Oxygen (except emergency).
(18) Parts and labor for repairs of durable medical equipment if originally separately payable or owned by the beneficiary.
(19) Physician services.
(20) Portable aspirator.
(21) Portable gas oxygen system and accessories.
(22) Precontoured structures (VASCO-PASS, cut out foam).
(23) Prescribed prosthetic and orthotic devices for exclusive use of patient.
(24) Reagent testing sets.
(25) Therapeutic air/fluid support systems/beds.
(26) Traction equipment and accessories.
(27) Variable height beds.
(28) X-rays.
(c) Not included in the payment rate nor in the Medi-Cal schedule of benefits are costs for personal items of beneficiaries such as cosmetics, tobacco products and accessories, dry cleaning, beauty shop services (other than shaves or shampoos performed by the facility staff as part of patient care and periodic trims) and television rental.
(d) Skilled nursing facilities and intermediate care facilities with the licensed bed capacities shown below meeting the standards and criteria established for intermediate care facility services for the developmentally disabled, as defined in Sections 76301 through 76413, Article 3, Chapter 8, Division 5, Title 22, California Code of Regulations, shall be entitled to payment according to the following daily rates. Payment for service includes the Quality Assurance Fee pursuant to Health and Safety Code Section 1324.2.
Total Licensed Beds
Ƞ
Effective
1-59
60+
60+ w/Distinct Part
Rate Year
Ƞ
2004-05
$143.95
$123.87
$123.87
2005-06
$158.58
$134.46
$134.46
2006-07
$158.58
$147.03
$147.03
(1) Reduced for leave of absence for all patients receiving intermediate care facility services for the developmentally disabled in accordance with Section 51535.
(2) Reduced for bed hold for acute hospitalization for all patients receiving intermediate care facility services for the developmentally disabled in accordance with Section 51535.1.
(e) Effective October 1, 1990, state operated facilities shall be entitled to payment for services at actual allowable cost.
(f) For purposes of this section, the rate year is August 1st through July 31st.
Authority cited:
Health and Safety Code 20
Welfare and Institutions Code 10725
Welfare and Institutions Code 14105
Welfare and Institutions Code 14108
Welfare and Institutions Code 14110.6
Welfare and Institutions Code 14110.7
Welfare and Institutions Code 14124.5
Reference:
Welfare and Institutions Code 14087.3
Welfare and Institutions Code 14108
Welfare and Institutions Code 14109.5
Welfare and Institutions Code 14110.4
Welfare and Institutions Code 14110.6
Welfare and Institutions Code 14110.7
Welfare and Institutions Code 14123
Health and Safety Code 1250
Health and Safety Code 1324
Health and Safety Code 1324.2
Health and Safety Code 1324.4
Health and Safety Code 1324.8
Health and Safety Code 1324.10
Health and Safety Code 1324.12
Statutes of 2004, Chapter 208, Items 4260-101-0001 and 4260-101-0890
Statutes of 2005, Chapter 38, Items 4260-101-0001 and 4260-101-0890
Statutes of 2006, Chapter 48, Items 4260-101-0001 and 4260-101-0890
(Amended by Register 2013, No. 52.)