BACKGROUND
Assembly Bill (AB) 186 authorizes the State of California to implement performance-based payments to incentivize workforce and quality improvements specific to Skilled Nursing Facility Long Term Care, also known as the Skilled Nursing Facility Workforce Quality Incentive Program (SNF WQIP).
In accordance with AB186, the duration of the SNFWQIP is from Jan. 1, 2023 to Dec. 31, 2025. Based on the State of California's Enacted Budget for State Fiscal Year 2025-26, the SNF WQIP will end on Dec. 31, 2025.
ELIGIBILITY REQUIREMENTS
Qualifying facilities include Freestanding SNF Level-B and Adult Freestanding Subacute Facility Level-B that are eligible to participate in the Medi-Cal program and furnish services under a Network Provider Agreement with Gold Coast Health Plan (GCHP). Freestanding Pediatric Subacute Care Facilities, Intermediate Care Facilities for the Developmentally Disabled Homes, Distinct Part Facilities, and SNFs with 100% designated special treatment program beds are not eligible for SNF WQIP.
QUALIFIYING BED DAYS
SNF WQIP qualifying bed days are calendar days during which a GCHP member receives SNF Level-B services inclusive of the first day of a member's stay and excluding the day of discharge unless it is also the first day of stay. Services rendered during the Program Year must be billed under a Network Provider Agreement with GCHP pursuant to applicable state and federal laws, regulations, and contractual terms for which Medi-Cal is the primary payer and where Medicare is no longer covering any portion of the bed day.
SNF Level B services include:
- Room and board
- Nursing and related care services
- Leave-of-absence days
- Bed holds
- Commonly used items of equipment, supplies, and services
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 mental health services 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
PAYMENTS
SNF WQIP payments will be made by GCHP to SNF WQIP-eligible Network Providers based on an interim and final per diem amount calculated by the state Department of Health Care Services (DHCS) for each Program Year. DHCS will aim to calculate quality scores and provide payment exhibits to GCHP to pay the interim per diem amount during the first part of the Calendar Year (CY) following the Rating Period, and the final per diem amount during the second part of the CY following the Rating Period.
GCHP is responsible for calculating the number of SNF WQIP qualifying bed days and paying the directed per diem amount for all Clean Claims for SNF WQIP qualifying bed days without regard to when these bed days are reported to DHCS, consistent with any reporting requirements applicable to the SNF.
GCHP is responsible for netting out any previously directed interim payment amounts from the final payment. GCHP is responsible for recouping or withholding any amounts related to Class AA or A citations from interim and final payments. See APL 26-006 for details on the Class AA or A citations.
GCHP will make payments to SNF WQIP-eligible Network Providers for qualifying bed days within forty-five (45) calendar days of receiving payment exhibits from DHCS or within thirty (30) calendar days of receiving a Clean Claim from the Provider, whichever is later. GCHP payments will designate that the payment is for the SNF WQIP with reference to the applicable Program Year.
INTEREST FOR LATE PAYMENTS
Requirements for Timely Payment of Claims, the amount of the SNF WQIP payment owed in accordance with APL 26-006 is considered a portion of a claim as defined in H&S section 1371. For any payment exhibits issued for SNF WQIP after March 30, 2026, GCHP owes the Provider interest on any unpaid amount owed at the rate of 15 percent per annum beginning on the first calendar day after the latter of either:
- Forty-five (45) calendar days after receipt of payment exhibits from DHCS applicable to the claim, as described above; or
- Forty-five (45) working days after receipt of claims, if on or before Dec. 31, 2025, or 30 calendar days of receipt of claims, if on or after Jan. 1, 2026.
GCHP will automatically include all accrued interest in any late payment.
DISPUTES
Any disputes to the SNF WQIP should be directed to the GCHP Long Term Services and Supports (LTSS) Liaison: Juan Rivero, Account Manager, jrivero@goldchp.org 805.832.3775, who will facilitate review and resolution of the dispute.
SNF WQIP CONTRACTED BED DAYS AND PAYMENT TOTALS
ADDITIONAL LINKS AND RESOURCES
Long Term Services and Supports (LTSS) Liaison: Juan Rivero, Account Manager, jrivero@goldchp.org 805.832.3775
SNF WQIP TRAINING CALENDAR
- 28 de oct. de 2026
- 9 de diciembre de 2026
To register for the upcoming SNF WQIP, please e-mail jrivero@goldchp.org with the following details. Upon receipt of the information, a confirmation e-mail will be sent with a link to virtual meeting details.
- SNF WQIP Training Registration in the e-mail Subject Line
- Name of SNF/LTC Facility/Facilities
- First and last name of attendee(s) with title(s)
- Contact Information of attendees (e-mail and/or direct phone number)
- Session attendees will be attending