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HR 4378 Ensuring Access to Quality Complex Rehab Technology Act
| Below is correspondence sent from Donald Clayback, Executive Director of NCART regarding their efforts related to HR 4378.
NCART Members and Friends,
Attached are newly published materials related to HR-4378, the "Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012", which was introduced in Congress last week. You will find a PDF of the actual Bill along with a one page Summary.
Last week's CELA 2012 Conference, held by NRRTS and NCART, provided a great kick-off for the introduction of HR-4378. The attendees (consumers, clinicians, suppliers, manufacturers, and other advocates) had over 250 in-person meetings with Congressional offices. In addition, information was dropped off at another 30 offices. There was a lot of positive energy and good initial response. Over the next two weeks CELA attendees will be following up with the people they met with to secure additional co-sponsors and generate support for passage. This will be supplemented by a national grassroots campaign.
With legislation now introduced, we will begin a much broader effort to secure additional co-sponsors and work to get the Bill attached to a larger piece of legislation and passed. The Separate Benefit Category Steering Committee (representatives from NCART, NRRTS, AA Homecare, RESNA, the Clinician Task Force, and the United Spinal Association) will continue to provide direction on the activities and decisions as the Bill moves ahead. So you have a map to follow, here is an outline of the key legislative steps:
1.) Get additional co-sponsors for HR-4378 in the House side of Congress.
2.) Get a companion Bill introduced in the Senate side of Congress and secure Senate co-sponsors.
3.) Get the Congressional Budget Office (CBO) to score the Bill and identify the additional cost to the Medicare program.
4.) Respond to questions and comments from Congressional offices and Committees.
5.) Get our Bill attached to a larger Bill so it can be brought to a vote and passed.
It's important to remember that although this legislation relates only to Medicare, our long-term objective is much broader. Once this legislation is passed and changes made within the Medicare program, the improvements will flow to Medicaid and other payers.
There is a long journey ahead, but we are now in the key legislative phase of the Separate Benefit Category initiative. You'll be hearing much more as we move into May and beyond. We will be creating a variety of tools to help in the advocacy efforts to get HR-4378 passed and there will be broad grassroots activities.
Thanks for everyone's efforts to get us to this point and thanks in advance for your continued commitment and participation.
Don
Donald E. Clayback
Executive Director
N.C.A.R.T.
716-839-9728 (office)
716-913-4754 (cell)
dclayback@ncart.us
www.ncart.us
Click here for a summary of HR 4378. Click here to view HR 4378. |
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Implementation of Medi-Cal Provider Payment Reductions
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Medi-Cal Phase I payment reductions included a 10% payment reduction for Durable Medical Equipment (DME) and medical supplies. The 10% payment reduction was implemented on December 24, 2011, and applied to claims processed after that date for DME and medical supplies rendered for dates of service on or after June 1, 2011. A 1% payment reduction had previously been in effect. The January 31, 2012, preliminary injunction that the federal court issued in the case of California Medical Association, (CMA) et al. v. Douglas prohibits the Department of Health Care Services (DHCS) from applying the 10% payment reduction for DME and medical supplies rendered for dates of service on or after January 31, 2012, but allows DHCS to apply the 10% reduction to DME and medical supplies rendered June 1, 2011, through January 30, 2012 that are either reimbursed for the first time on or after January 31, 2012 or reimbursed prior to January 31, 2012, at the 10% reduced payment level. In other words, DHCS is enjoined from retroactively applying the 10% reduction to DME and medical supplies rendered June 1, 2011, through January 30, 2012, if the provider was reimbursed prior to January 31, 2012, at the 1% reduced payment level.
There are approximately seven different provider types that are authorized to bill for DME and medical supplies; however, these providers are also authorized to bill for other services for which a 10% payment reduction has not been enjoined. In order to comply with the preliminary injunction by stopping the 10% payment reduction for DME and medical supplies, without stopping the 10% payment reduction on other services these providers render, it was necessary for DHCS to work with its Fiscal Intermediary, Affiliated Computer Services (ACS), to stop the 10% payment reduction on approximately 2,500 separate procedure codes that providers are authorized to use in billing for DME and medical supplies. DHCS expects to implement these extensive changes on or after April 21, 2012, so that payments on claims processed after that date, for DME and medical supplies rendered on or after January 31, 2012, will be not be reduced by 10%.
DHCS will be developing and implementing an erroneous payment correction (EPC) to reprocess claims for DME and medical supplies rendered on or after 1/31/12 that were reimbursed with the 10% payment reduction to pay providers additional money they are owed. DHCS will notify impacted providers prior to the implementation of the EPC to pay providers what they are owed.
If and when the preliminary injunction is reversed on appeal, DHCS will reinstate the 10% payment reduction for all DME and medical supplies rendered on or after June 1, 2011, and take action to recoup from providers the overpayments that will have resulted from not applying the 10% payment injunction. Medi-Cal Phase I payment reductions also included a 10% payment reduction for Adult Day Health Care (ADHC) Claims through February 2012 as a result of the settlement agreement in the Esther Darling et. al. v. Toby Douglas court case. However, due to the ADHC Benefit extension through March 2012, the 10% payment reduction shall be extended through March 31, 2012. Subsequently, the new Community-Based Adult Services (CBAS) program will replace the current ADHC program. All payment reductions and exemptions applicable to ADHC will also be applied to CBAS Claims. Therefore CBAS Claims shall receive a 10% payment reduction beginning on April 1, 2012. All ADHC/CBAS Providers currently exempted from the 10 percent reduction are noted on the DHCS website in a list entitled, AB 97 10% Provider Payment Reduction: Exempt Adult Day Health Care Facilities.
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Medi-Cal Will Begin Accepting & Transmitting X12N 5012 & NCPDP D.0/1.2 Transactions Beginning June 25, 2012
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As previously announced, Medi-Cal will begin to accept and transmit X12N 5010 and NCPDP D.0/1.2 transactions beginning June 25, 2012. Consistent with current processes, submitters must successfully test the new formats before sending transactions to CA-MMIS production environment. In order to support submitters that want to complete this testing process in advance of June 25, Medi-Cal has developed a schedule for current submitters. A letter is going out by the end of this week to current submitters with the date that they are scheduled to test. If they cannot test in that scheduled week, they will be asked to provide alternate date or dates. Instructions/guidelines will also be provided in that letter. However, Medi-Cal will continue to accept ASC X12N 4010A1 and NCPDP 5.1/1.1 transactions for those submitters that choose not to transition, or do not successfully pass all applicable test transactions. A date for termination of the ASC X12N 4010A1 and NCPDP 5.1/1.1 formats will be forthcoming.
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DMEPOS Competitive Bidding Round 1 Recompete Announced
| CMS announced plans to recompete the supplier contracts awarded in the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. CMS is required by law to recompete contracts under the DMEPOS Competitive Bidding Program at least once every three years. The Round 1 Rebid contract period for all product categories, except mail order diabetic supplies expires on December 31, 2013
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California's March Revenues Fall $233.5M Short of Projections
| California Controller John Chiang reports that March revenues were $233.5 million below expectations. Legislators are holding off on taking any action until Gov. Brown issues a revised budget plan. Sacramento Bee's "Capitol Alert," Capital Public Radio's "KXJZ News."
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Consumers Turning to Social Media to Search for Health Information
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A PricewaterhouseCoopers survey finds that about one-third of consumers use social media to access health information. More than 80% of respondents ages 18 to 24 say they would use social media to share health data. Computerworld's "Government IT," Health Data Management.
Click here for full article.
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