25-306 DHCS Will Provide Directed Payments to Facilities to Incentivize Workforce and Quality
Date: 04/10/25
New SNF workforce and quality incentive program (WQIP) payments authorized for dates of service Jan. 1, 2023 through Dec. 31, 2026
The Department of Health Care Services (DHCS) announced in All Plan Letter (APL) 25-002, dated January 13, 2025, a change to Assembly Bill (AB) 186. AB 186 amended the Medi-Cal Long-Term Care Reimbursement Act to improve the financing method relevant to:
- Freestanding skilled nursing facilities (SNFs) level-B and
- Adult freestanding subacute facilities level-B.
AB 186 also created a new program, the SNF WQIP. The program encourages facilities to improve quality of care, advance equity in healthcare outcomes and invest in their workforce. WQIP functions as a directed payment program in the Medi-Cal delivery system for eligible network providers. WQIP is authorized by AB 186 for dates of service Jan. 1, 2023, through Dec. 31, 2026.
The SNF WQIP payment program is intended to:
- Better incentivize and hold facilities accountable for quality patient care.
- Stress the critical role of the workforce.
- Better balance distribution of annual rate increases.
- Result in the long-term financial viability of facilities in the Medi-Cal managed care environment.
For more information on the SNF WQIP, go to the DHCS website.
Program payments, grievances and contacts
- How payments will be processed
- Health Net will issue payments to the providers via checks or ACH payments to SNF WQIP eligible network providers:
- For qualifying bed days within 45 calendar days of receiving the
Per Diem Exhibits from DHCS, or - Within 30 calendar days of receiving a clean claim from the provider, whichever is later
- For qualifying bed days within 45 calendar days of receiving the
- How to file a provider grievance
- Detailed instructions on filing a provider grievance are available in the Provider Library > select line of business > Provider Manual > Appeals, Grievances and Disputes > Grievances.
- Note: Provider grievances may be submitted over the phone or in writing within 180 days of the date of occurrence.
- How to identify a responsible payer
- For questions on how to identify the responsible payer of WQIP eligible days, SNF WQIP eligible network providers can reach out to Health Net’s long-term services and supports (LTSS) liaison contact:
Edward Mariscal – WQIP Point of Contact
Director, Population Health
Email
Phone: 909-293-6974
Bed days data sharing
DHCS will provide Health Net with data reflecting all SNF bed days reported by Health Net to DHCS on a quarterly basis. Health Net will work to reconcile the data against our records and provide each SNF WQIP-eligible network provider with a summary level report. These summary level reports will be sent to all SNF WQIP-eligible network providers in a manipulatable digital format within 30 calendar days of receiving the data from DHCS. If there is a possible discrepancy in the summary level report, Health Net will work with the SNF WQIP-eligible network provider to reconcile the data, which will include providing member-level data and claims, in a machine-readable format, to the SNF WQIP-eligible network provider upon request.
Upcoming SNF WQIP Webinars
Register and attend upcoming SNF WQIP webinars to learn more about the program.
Topics | Dates | Time (PT) | Registration |
|---|---|---|---|
Skilled Nursing Facility (SNF) Workforce & Quality Incentive Program - Partnership with Health Net
|
Tuesday |
2 – 3 p.m. |
|
Tuesday |
2 – 3 p.m. |
|
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone at 800-675-6110 or through the Health Net provider portal.
This information applies to Ancillary Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.