In This Issue
Update on Medi-Cal Rate Cut Injunctions
DHCS Announces New Requirement


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CAMPS UBL Webinar April 19, 2012 
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California HME Update
Update on Medi-Cal Rate Cut Injunctions and DHCS Fix
 

On Wednesday the Ninth Circuit Court of Appeals denied the request by DHCS for an emergency stay on the injunction that halted the 10 % provider rate reductions. That means pending the actual briefing, hearing and final decision on the state's appeal of the ruling that the injunction will stand. It is estimated that the Court of Appeal could rule in the Summer.

 

In the meantime, the various injunctions issued at different times to different groups of providers have been consolidated into one case. The earlier injunctions issued to one pharmacy group, hospitals and non-emergency medical transportation have been joined to the case brought by CAMPS, CMA, Ca. Dental Assoc., CPhA and ambulance providers.

 

CAMPS has also been informed that DHCS has started the actions listed below to reverse the rate reduction for DME that began on 12/22/11. Depending on what specific types of codes you bill you may have seen the reimbursement amount already changed back or you still might see the lower amounts on your EOMBs. The effective date for the injunction is 1/30/12 so any claim paid on that date or after at the reduced amount will automatically be re-processed and the difference paid. Here is the DHCS implementation plan;

 

  • CA-MMIS system changes will be implemented to utilize procedure code exemptions for approximately 2500 procedure codes by end-dating the 10% reduction with 1/30/12 date.
  •  Implementation of CA-MMIS system changes are anticipated to happen over the next 5 weeks.
  • After the CA-MMIS system changes to end-date 10% reduction are implemented, an Erroneous Payment Correction (EPC) will be implemented to retroactively reprocess the DME/MS claims for dates of service between 1/31/12 and the date the CA-MMIS system changes are implemented, to return the funds to affected providers.

   

 

DHCS Announces New Requirement for Medi-Cal Provider Enrollment

DHCS is sponsoring SB 1529 ( Alquist) that would make numerous changes to the provider enrollment process for Medi-Cal. Most of these changes are required based upon the federal adoption of the Affordable Care Act and requires state Medicaid plans to conform to these provisions or risk loss of federal matching funds. As you might expect the application form will get longer and adopt new provisions based upon the relative degree of risk or provider type for fraud and abuse. You might guess that DME providers are in the "high" risk category.

 

We will discuss more of the specifics as the bill is amended and heard in its first committee.  Among the changes;

 

  • Require provider claims to list the NPI of the referring physician.
  • Require that any practitioner who orders goods or services for a Medi-cal enrollee to also be enrolled in the program. Currently you only need to be enrolled if you bill the Medi-Cal  program for services.
  • Establish provider application fees, only for new providers or locations unless that provider is already enrolled in Medicare.