Update on Medi-Cal 10% Provider Rate Cut  

CAMPS is a plaintiff in the small  provider coalition that has filed a request for an injunction to halt the 10% provider rate cut and efforts to recoup payments at those rates back to June 1, 2011. The hearing will occur on 1/30/12  in Federal District Court in Los Angeles. Judge Snyder who will hear the matter has granted several injunctions on similar matters over the past month involving similar petitions by hospitals and pharmacy groups. These previous injunctions are in effect but DHCS has indicated that they will appeal or request a stay in the order.

It also appears that Medi-Cal has implemented the 10% reduction for DME effective 12/22/11 but not seen in provider checkwrites until 1/14/12. This is the reduction and not any recoupment back to 6/1/11. We have also heard from some providers that they are also seeing reductions for medical supplies. We would encourage all of our members to scrutinize their recent checkwrites and determine what services are experiencing the 10% reduction. We had assumed that DHCS would not implement these reductions pending the outcome of our hearing but that was not the case. We would expect the Court to rule fairly quickly, e.g. before the end of next week.

We also have additional information on likely DHCS actions regarding the efforts to recoup the 10% reduction going back to June 1, 2011. That will be done via EPC ( Electronic Payment Correction) now scheduled to begin in late February or early March. DHCS indicates that for individual providers they will not recoup more than 5% of the total overpayment in each checkwrite. This is initial information and subject to confirmation by DHCS in the coming weeks. Any recoupment effort obviously could be curtailed by the issuance of an injunction as described above.

We will keep our members informed as more information becomes available. CAMPS is committed to this litigation and needs financial support from our members for this effort. If you have not already considered a contribution please do so today. Additional information on how to contribute and a form is available at www.campsone.org.