We are still awaiting CMS action on the State Plan Amendment (SPA) request from  DHCS to implement the Medi-Cal changes in the approved 2011-12 state budget. Most important is the 10% provider rate reduction that was set to take effect on July 1, 2011. We have told you about CAMPS participation in the provider coalition effort to urge CMS to not adopt the SPA changes. There have been  meetings in San Francisco with CMS Region IX and with Dr. Berwick in Washington, DC. There is no news as of yet.

We have learned that as of yesterday DHCS has announced the timing for implementation of the change in Medi-Cal coverage or oral administration of enteral formula. The earlier Medi-Cal cuts had eliminated coverage of oral nutrition for adults that would be triggered after SPA approval. Since that had not happened providers would have expected at least a 60-day window prior to change. DHCS was informed by CMS recently that this change was a utilization control change and not a benefit change, hence SPA approval is not necessary. There will be a Provider Bulletin issued in September that will officially announce the change effective 10/1/11. Here is a link to all the details

http://www.dhcs.ca.gov/Pages/BudgetActions.aspx

TARs issued prior to 10/1/11 will be honored and approved through their authorization. Any new TARs issued 10/1/11 or later will be issued according to the new coverage criteria.

Meanwhile the news on the viability of the budget adopted in June continues to be bad. Actual State revenue received in July is less than the forecasted amounts. Legal challenges to pieces of the budget solution, like redevelopment funding changes are being litigated and the California Supreme Court has enjoined implementation until they issue a ruling. It appears likely that late this fall the Legislature may be back in Special Session to address yet another mid-year budget problem. Sound familiar ? Under the budget agreement adopted if the numbers don't work it will trigger additional state spending cuts in January.