DHCS Updates Skilled Nursing Facility Rates for 2024-2026
The Department of Health Care Services (DHCS) has published updated rates on file for freestanding skilled nursing facilities and subacute facilities for calendar years 2024, 2025, and 2026. Facilities should promptly confirm that their published rates and managed care payments are accurate, particularly after a change of ownership or Workforce Standards Program opt-in.
What DHCS Announced
DHCS stated that the October update reflects recent Workforce Standards Program opt-ins and changes to facility names, rates, and National Provider Identifiers following changes of ownership. DHCS also announced that it intends to update the rates on file on the 15th of each month and has directed Medi-Cal managed care plans to review those updates.
DHCS reiterated that, following a change of ownership or licensed operator, the facility generally continues to receive the per diem rate in effect for the prior owner. Plans should identify that rate using the facility’s HCAI identification number and should not require a separate DHCS rate letter before implementing it.
Why the Update Matters
The revised files reach back to 2024 and may affect claims already paid. Some facilities may be entitled to additional retroactive reimbursement. Others may receive adjustment or recoupment notices. Facilities should not assume that a plan’s calculation, effective date, or recovery method is correct.
The announcement also may produce disputes with plans over payment for many reasons. These disputes may be subject to contractual Provider Dispute Resolution procedures with timliness limitations.
Recommended Review
- Confirm the facility name, NPI, HCAI identification number, and published rate for each affected year.
- Compare the updated rates against managed care remittance data for 2024, 2025, and 2026.
- Identify unpaid retroactive increases, unexplained reductions, offsets, or recoupment notices.
- Preserve all plan-specific provider dispute and appeal deadlines.
- Review whether a change of ownership or other issue should affect payment.
