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SNF WQIP

Overview

  • The Skilled Nursing Facility (SNF) Workforce & Quality Incentive Program (WQIP) incentivizes facilities to improve quality of care, advance equity in healthcare outcomes, and invest in workforce. SNF WQIP functions as a directed payment program for eligible network providers. SNF WQIP is authorized by Welfare & Institutions Code Section 14126.024 (added by Assembly Bill (AB)186 (Chapter 46, Statutes of 2022)) for dates of January 1, 2023, through December 31, 2026.

SNF WQIP Eligible Network Providers

  • Must be a contracted SNF Provider
  • Freestanding SNF Level-B
  • Adult Freestanding Subacute Facility Level-B

SNF WQIP Ineligible Providers

  • Freestanding Pediatric Subacute Care Facility
  • Intermediate Care Facilities for the Developmentally Disabled (ICF/DD)
  • Distinct Part SNF (Hospital-Affiliated)
  • SNF where 100% of beds are Designated for Special Treatment Program Services
  • SNF where all beds are designated for hospice care

SNF WQIP Eligible Bed Days (A facility’s bed days must)

  • Be for Medi-Cal Managed Care members (Additional clarification Pending from the DHCS)
  • Be billed under a Network Provider Agreement with an MCP
  • Include room and board, nursing services, and commonly used equipment/supplies as per Medi-Cal regulations

SNF WQIP Payment Process

  • SNF WQIP payments are calculated using the per diem incentive rates established by the Department of Health Care Services and in accordance with the criteria outlined in All Plan Letter (APL) 26-006. Payments are issued twice for each program year, an interim payment and a final reconciliation payment.
  • The DHCS will provide Kern Family Health Care (KFHC) with specific per diem exhibits and once received KFHC will have 45 calendar days from the date of receiving the exhibits to issue payments to all eligible SNFs. Delay in receiving funds may delay payment.
  • Qualifying bed days are determined based on encounters accepted by the DHCS. KFHC will share qualifying summary level data with contracted providers. Providers are responsible for reviewing the information provided and notifying KFHC of any discrepancies.

Determination of Responsible Payer

  • The payer responsible is determined based on the members’ assignment and eligibility information provided by the DHCS during applicable dates of service.

Provider Grievance

LTSS Liaison

For more information, please visit the DHCS SNF WQIP Website