General Information

The Fee-For-Service-Rates Development Division (the "Division") at the California Department of Health Care Services (the "Department") requests the participation of Medi-Cal long-term care providers to complete this survey.  Your participation will help the Department study the effects of Senate Bill 3.  Participation in this survey is voluntary.  The Department does not intend to disclose these survey responses to anyone outside of the Department.

Thank you for your participation!

If you have any questions or concerns, please contact the Long Term Care Section System Development at or (Intermediate Care Facilities for the Developmentally Disabled [ICF/DDs, ICF/DD-Hs, or ICF/DD-Ns] only) with the subject line “SB 3 Wage Impact Survey”.  The Division shall, upon request, inform interested survey respondents regarding the location of their records and the categories of any persons who use the information in those records. The Division shall, upon request, make available to any interested respondents their own survey results.

For consistency, we request that a survey be completed for each responding facility. If you have multiple facilities, please complete one survey for each. If you have multiple services in one location, please complete one survey for all of the services provided at that facility.

The respondent is responsible for providing accurate and reasonable information in the survey.  The Department will review all survey responses for accuracy and reasonability and will exclude any surveys or information determined to be erroneous or incomplete.  The responsibility for the integrity of the information submitted rests upon the party providing the information and not the Department. The Department reserves the right to verify information provided if questions arise about integrity or accuracy of the data submitted.  Please respect and comply with all relevant privacy laws when answering questions in this survey.  Refrain from providing unnecessary detail or information that may compromise privacy.

* Contact Information

* Type of facility