What is a Nursing Home in California?

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All nursing homes in California must be licensed by the California Department of Public Health (DPH) and meet California nursing home standards.

In addition to being licensed, nursing homes that choose to participate in the Medicare and Medi–Cal programs must be certified by the federal government in order to qualify for payments from these programs. Federally certified facilities must meet federal standards as well as the California requirements. Most California nursing homes are certified to participate in both Medicare and Medi–Cal.

All nursing homes are not alike. There are several types of licensing and certification categories for nursing homes, which are described below:

Most nursing homes in California are licensed as Skilled Nursing Facilities (SNFs), which California broadly defines as a health facility that provides skilled nursing and supportive care to persons who need this type of care on an extended basis.

Medicare also uses the term “skilled nursing facility” for nursing homes that are certified to receive its payments. Medi–Cal uses a similar term, “nursing facility (NF),” for nursing homes that are certified to receive Medi–Cal payments. Most, but not all, licensed skilled nursing facilities in California are certified to participate in Medicare and Medi–Cal.

A Distinct Part/Skilled Nursing Facility (DP/SNF) is a hospital–based facility, usually operated in a designated unit within a hospital. These facilities are paid higher Medi–Cal rates than freestanding nursing homes.

Medi–Cal contracts with certain skilled nursing facilities to provide subacute care to adults and children who need specialized care. Subacute care is a Medi–Cal program (not a licensing or certification category) that pays higher rates for Medi–Cal beneficiaries who have exceptional needs, such as ventilator care.

Intermediate Care Facilities (ICFs) are a lower level of nursing home licensed by the California Department of Public Health to provide inpatient care to persons who do not require continuous nursing care, but do need nursing supervision and supportive care. Most ICFs are certified by Medi–Cal and qualify for its payments, although at a lower rate than skilled nursing facilities. Medicare does not certify or pay ICFs, although Medicare beneficiaries who reside in ICFs can use Medicare for covered health services, such as physician care.

Additionally, California licenses three subcategories of ICFs that serve persons with Developmental Disabilities: (1) ICF/DD (Intermediate Care Facility/Developmentally Disabled); (2) ICF/DD–N (Intermediate Care Facility/Developmentally Disabled– Nursing); and (3) ICF/DD–H (Intermediate Care Facility/Developmentally Disabled–Habilitative).

Some nursing homes, classified as Institutes for Mental Disease (IMDs), provide care for residents with mental health disorders. In California, these skilled nursing facilities are designated as special treatment programs (SNF/STPs).

Continuing Care Retirement Communities (CCRCs) provide housing (independent living), assisted living, and nursing care, usually in one location. Residents pay a large entrance fee at admission and sign a contract that entitles them to future care, sometimes for life. CCRCs are primarily regulated by the California Department of Social Services. Additionally, CCRCs that operate a skilled nursing facility must be licensed by the California Department of Public Health.