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News from CMS on Medi-Cal Provider Rate Cut
On September 28th CMS sent a request for additional information to DHCS on their State Plan Amendment (SPA) that included the 10% Medi-Cal provider rate cut effective June 1, 2011. That request stops the clock on the 90-day SPA approval cycle. A new 90-day clock would start once DHCS submits the requested information to CMS.
We do not know the details of the specific information requested but assume it would relate to data on the potential access issues that might occur with the provider rate reductions. DHCS has submitted data to CMS on that issue in the past but has heretofore refused to release that data to the provider community or the media. A legal action was filed last Friday by the CMA and the CA Pharmacists Association to demand release of that information.
This does not end the issue and CMS may eventually still approve the reductions. We are informed that it is likely that CMS will issue approval on the 1% provider rate reduction that has been in effect since March 1, 2009. There also remains a risk that if CMS does eventually approve the 10% cut that it could be retroactive to 6/1/11.
Meanwhile this last Monday the US Supreme Court heard oral argument on the appeal by DHCS on the previous Federal Court injunction that was issued against the Medi-Cal provider rate reductions that were supposed to take effect in 2008. You will recall that those cuts were stopped in August 2008 for many providers including physicians. For pathologists it meant that the cut did not impact you unless you billed as a clinical lab. The 10% cut ended for clinical labs as of Feb. 28, 2009 and transitioned to a 1% reduction that then applied to almost all types of providers. This is a case that questions the abilities of providers to have legal standing to bring a legal action to challenge Medicaid program reductions. This is an important case that has drawn the support of the Obama administration for the position of DHCS and against the provider community. A decision is not expected until next spring.
Important Notice From Medicare
Revalidation Initiative: Frequently Asked Questions (FAQs)
All new and existing providers enrolled with Medicare prior to March 25,
2011, must revalidate their enrollment information in accordance with the
Patient Protection and Affordable Care Act, but only after receiving
notification from the MAC. Even if your records were entered into PECOS on
March 24, 2011, you are still required to revalidate the information. The
frequently asked questions in this article will help you with this request.
Please share with appropriate staff. Please click here for more information.
SAVE THE DATE October 18-21 2011 MACtoberfest Palmetto GBA J1's largest educational and networking event of the year! Join us October 18 through October 21, 2011, in San Diego and receive multiple Continuing Education Unit (CEU) credits for all the sessions you complete. Look out for more details on our J1 Part A or Part B Web sites in the next few weeks. Click here for more information on the 2011 MACtoberfest. November 29 - December 3 California Society of Pathologists 64th Annual Convention "Seminars in Pathology" Hyatt San Francisco in Embarcadero Center 5 Embarcadero Center San Francisco, CA 94111 Please click here for online registration. Please click here for the Conference brochure. Please click here for hotel reservations. | 
