California HME Update

CAMPS File Appeal on Upper Billing Limit Regulation Litigation

The CAMPS Board authorized our outside counsel to file an appeal of the decision in our Writ of Mandate effort to repeal the Upper Billing Limit regulation that governs the Medi-Cal program. That regulation in effect since 2004 prohibits a Medi-Cal provider form billing more then 100% more then the "net purchase price" for dme and medical supplies. There is a statement in a recent Medi-Cal Bulletin indicating the Department's understanding that the UBL also applies to enteral formula.

Our challenge to the legality of the regulation was rejected in Alameda Superior Court and on October 2nd we filed a notice of appeal with the Court of Appeal. It will be several months before briefs are filed and oral argument occurs. We would not anticipate a decision until summer of 2010. CAMPS has expended all of the funds contributed by members to the Legal Fund and dipped into reserves to pursue the initial phase of the litigation. We encourage members to consider another contribution to the Legal Fund to help us pursue the appeal. More information is available on the CAMPS website at www.campsone.org.

Good Progress on Effort to Recoup Medi-Cal 10% Provider Rate Cut

We are all painfully aware of the 10% Medi-Cal provider rate that was instituted by the Legislature as part of the budget fix on July 1, 2008. Some providers were able to obtain injunctive relief against the cut in federal court late in 2008 but dme and medical supplies were subject to the cut until March 1, 2009 when it reverted to a 1% reduction. CAMPS did file a Motion to Intervene in Federal Court last November, but the Motion was denied without prejudice, i.e. could be filed again, by the federal court pending the outcome of the appeal by DHCS on the injunction that stopped the 10% cut for pharmacy (drugs only), physicians and others.

The appeal by DHCS was denied earlier this year and the injunction was unanimously approved by the federal Court of Appeal. As a result the Federal District Court was authorized to convene a settlement conference and prepare a final order for the injunctive relief, which would include retroactive relief back to July 1, 2008. A Federal Magistrate has been in charge of those discussions and CAMPS legal counsel has been participating in the meetings. We have re-filed our Motion to Intervene with the intent that the retroactive relief be applied to dme and medical supplies as well.

Another settlement conference meeting will occur on 11/2/09 but our counsel is very optimistic that we will be afforded relief from the cut and repayment of the 10% that was withheld during that time period. We will inform you once this decision is finalized and provide information as to how that will be implemented.