The Legislature has passed and the Governor has signed a budget for 2011-12. It was the first on-time budget in many years. It relies on a somewhat rosy forecast of increasing state revenues to avoid even steeper budget cuts. Whether these assumptions stand up over the course of the fiscal year remain to be seen.
As you know part of the budget cuts that were adopted earlier in the year include a 10% provider rate reduction for Medi-Cal providers that was intended to take effect on June 1, 2011. It was unclear whether DHCS had submitted a State Plan Amendment( SPA) to CMS to allow for this change to the Medi-Cal program. CAMPS participated in a group provider meeting with CMS Region IX in San Francisco on July 5th. Our thanks to Jerry Knight from ATG Rehab who attended the meeting.
We learned that DHCS submitted the SPA to CMS at the end of June. CMS has 90 days to review the proposal, which could extend longer if there are changes or greater discussion needed. This SPA contains a number of dramatic changes in addition to the provider rate reduction which include patient co-pays and a soft cap on physician visits. The provider representatives emphasized the likely impact on access of additional provider rate reductions. CMS indicated that they would review the SPA and might "negotiate" with the State over some of these changes. The timing and outcome of this process is still unknown. In addition, the U.S. Supreme Court will likely rule this fall on the prior federal court enjoining of the 2009 provider rate reduction .
We would like to provide direct information to CMS on the impact of the rate cut on DME/medical supply provider participation. Please take a few moments to respond to the survey question posed below.
Click here to answer survey question.
Update on Status of Change in Coverage of Oral Enteral Nutrition
We have previously informed you of the budget driven change to limit Medi-Cal coverage of enteral nutrition to only tube fed patients with limited exceptions. That change could have taken effect on June 1, 2011 but DHCS was also awaiting federal approval from CMS via the SPA process. We are told that DHCS has requested that the implementation date now be September 1, 2011 and that a SPA has been submitted. That date could be later since the statute requires, "the enteral nutrition product limitations shall be implemented June 1, 2011, or the first day of the first calendar month following 60 days after the date the department secures all necessary federal approvals to implement, whichever is later".
We will alert you once an implementation date is determined.
CAMPS Action Corrects CCS Claims Processing Issue on Suction Pumps
CAMPS was alerted to claims processing problems in June by a provider. As a result of the new edits from NCCI we are seeing cases where claims involving more than one unit for some types of DME for an individual patient, like vents or suction pumps, are being denied even where there is a CCS SAR approving two units. The notice below will be contained in the July Medi-Cal Bulletin.
NCCI/Medi-Cal Claims Processing Discrepancy: Respiratory Suction Pumps
Effective immediately, claims for HCPCS code E0600 (respiratory suction pump, home model, portable or stationary, electric) will no longer be automatically denied for exceeding the National Correct Coding Initiative (NCCI) quantity limit when the claims are submitted with documentation of medical necessity. Providers may submit a Treatment Authorization Request (TAR) or Service Authorization Request (SAR) with justification that a back-up suction is medically necessary. Providers' claims for respiratory suction pumps that were denied due to the NCCI quantity limit will be reprocessed and reimbursed based on previous Medi-Cal policy.
Providers will be allowed 2 with a SAR (or TAR) and they will go back and reprocess the denied claims.
Medicare Eligibility System Notice
CAMPS has been asked by Noridian Medicare to notify our members of the following:
- There is a problem with the national eligibility file causing the Interactive Voice Recognition System (IVR) not being able to return eligibility and same or similar results and Endeavor not being able to return same or similar results.
- Have your staff either use Endeavor for eligibility or call the IVR later in the week.
- The Call Center is extremely busy and hold times may be long.
