Skilled Nursing Facility Workforce and Quality Incentive Program

Purpose: To provide an overview of the Skilled Nursing Facility Workforce and Quality Incentive Program (SNF WQIP) and CY2023 Final Payment Process

SNF WQIP Overview

  • Implemented pursuant to Assembly Bill (AB) 186 amendment which authorized the state to implement SNF WQIP
  • Objective: To provide performance-based payments to incentivize workforce and quality improvements
  • Duration: January 1, 2023 - December 31, 2026.
  • Program Years: PY 1 (2023), PY 2 (2024), PY 3 (2025), PY 4 (2026). 

Eligibility Criteria

  • Eligible Facilities: Freestanding SNF Level-B and Adult Freestanding Subacute Facility Level-B that furnish service under a network agreement with Molina Healthcare of California (MHC).
  • Exclusions:
    • Freestanding pediatric subacute care facilities
    • Intermediate care facilities for the developmentally disabled homes
    • Distinct part facilities
    • SNFs with 100% designated special treatment program beds

Qualifying Bed Days

  • Calendar days during which a member receives SNF Level-B services including the first day of stay but excluding the discharge day (unless it's also the first day).
  • These services must be provided during the PY, billed under a Network Provider Agreement with MHC, with Medi-Cal as the primary payer and no Medicare coverage for the bed day.
  • SNF Level B Services include: Room and board, nursing and related care services, leave-of-absence days, bed holds.
  • Exclusions:
    • Hospice Bed Days: Bed days reimbursed for hospice services are not qualified for SNF WQIP payments.
    • Special Treatment Program (STP) Services: Bed days receiving reimbursement for STP services for the mentally disordered are not qualified.
    • Facilities with 100% STP or Hospice Beds: Facilities where all beds are designated for STP and/or hospice services are not qualified.
    • Non-Network Provider Agreement: Bed days reimbursed outside of a Network Provider Agreement are not qualified.
    • Secondary Payer: Bed days for which Medi-Cal is a secondary payer are not qualified.

Payment Process

  • For PY 1, DHCS will calculate the final separate payment term made by DHCS to MHC based on qualifying bed days that are reported by MHC to the Post-Adjudicated Claims and Encounters System (PACES) by October 15, 2024, and that are accepted by DHCS.
  • For PY 2 and subsequent PYs, DHCS will calculate the final separate payment term made by DHCS to MHC based on qualifying bed days that are reported by MHC to PACES by June 30 following the PY and that are accepted by DHCS.
  • DHCS will provide MHC with data reflecting all SNF bed days reported by MHC to PACES on a quarterly basis.
  • MHC reconciles the data against the internal records for reporting and payment.
    • Facilities with Class AA and A Citations partly or wholly in the PY are be identified using the CDPH State Enforcement Actions Dashboard
      • Class A citation: A 40% penalty applies for that PY
      • Class AA Citation: are disqualified from payment for that PY

Timeline

  • DHCS disseminates Final Per Diem Exhibits for each facility quarterly
  • MHC calculates the number of qualifying bed days data for each facility from internal claims sources following SNF WQIP eligibility criteria
  • For clean and complete SNF WQIP qualifying claims, payment is issued within 45 days of receiving CY 2023 PY1 SNF WQIP Final Per Diem Exhibits from DHCS
  • Payments will be net of any previously paid directed interim payment amounts

Data Reconciliation

  • MHC provides each SNF WQIP-eligible Network summary level reporting including specified data fields in the DHCS APL 25-002 within 30 days of receiving the data from DHCS
  • Facilities outreach to MHC-SNF-WQIP@MolinaHealthcare.com regarding any questions or discrepancies

Resources

Upcoming Training 

MHC is hosting an educational session in April to review the SNF WQIP CY2023 Final Payment. 

Date: Wednesday, April 30, 2025
Time: 10:00 AM - 11:00 AM PT
REGISTER