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Update on Budget Deliberations - More than Provider Rate Reductions
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As the 6/15 budget adoption deadline approaches for the 2012-13 state budget we thought we would fill you in on two issues that are of interest to CAMPS members. Both issues have been part of the current budget discussions based upon proposals from the Administration.
First, is the upcoming Dual Demonstration project that would enroll Medi/Medi patients in managed care programs. It was intended to begin on 1/1/13 with a "pilot" effort in up to 10 counties. That pilot included the vast majority of these patients since it included large counties like LA, Orange and San Francisco. There are 685,000 dual eligible patients with some limited exclusions for certain categories of patients. Concerns were raised with the scope of the pilot, the timeline, and the need for additional input from the provider and patient community on the enrollment process and provider participation. Though the language is not yet final or adopted there are two changes that have already been incorporated into the Administration's plans and been submitted to CMS for approval. The first is to limit the pilot to 8 counties and not 10 . Here is a breakdown of the plan indicating which counties become part of the program in each year as it evolves form a pilot to the entire state;
2013 (8 Counties)
Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara
2014 (22 Counties)
Contra Costa, Fresno, Kern, Kings, Lake, Madera, Marin, Mendocino, Monterey, Napa, San Francisco, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, Sacramento and Yolo
2015 (28 Counties)
Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake Lassen, Mariposa, Modoc, Mono, Nevada, Placer, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba
There has also been a delay for the program to begin now establishing a time frame of no earlier than March 1, 2013 and no later than June 1, 2013. It is a one year transition meaning that those eligible in those counties are enrolled by their birth month. CAMPS members need to be aware that much like the SPD transition this means that patients you are now serving will be transitioning to managed care and you need to be a member of those networks. To keep track of new developments with the Duals Project you can see updates at www.CalDuals.org. CAMPS continues to participate in stakeholder discussions on project design and provider outreach.
The second Medi-Cal budget issue was a proposal from DHCS called Value-Based Purchasing. In broad terms it allowed DHCS to bypass the normal regulatory process for determining what services are covered and how they are paid for. It would substitute the regulatory process that would propose changes in coverage of a particular procedure or supply with a fast track stakeholder input process that could allow change to occur in 60 to 90 days. That could be anything from eliminating coverage of an item of DME or disposable supply to changes in how they are paid for or bundled in other provider payments. CAMPS joined a variety of other healthcare organizations in expressing concerns with the magnitude of this authority. Both Budget sub-committees saw similar concerns with the breath of the proposal and have asked DHCS to re-tool the concept. They will score 50% of the original savings of about $75 million but adopting some general policy for DHCS to continue to reimburse for services that do have medical and therapeutic value, but otherwise no change to the statutory or regulatory system for changes in the program.
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Governor's May Revise on the Budget for 2012-13
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You have probably seen the reports on the Governor's May revise proposal on the state budget. The deficit has grown to nearly $16 billion for the next fiscal year due to revenues being under projection as well as some savings made with cuts not materializing, e.g. Medi-Cal provider rate reductions and mandatory co-pays.
The Governor revised plan seeks to solve that gap with some additional cuts and hopeful November voter approval of his initiative to raise the sales tax and income tax rates. The latter might provide up to $8 billion in new revenue. The Governor's suggested budget cuts do include Medi-Cal and Social Services but impact SNFs and hospitals in terms of some specific rate methodologies. There are suggested changes to the 2013 pilot program for dual eligibles Medi/Medi's which are described below;
Revised budget trailer bill legislation is pending, with the major changes proposed to the Coordinated Care Initiative as follows:
- Implementation date - In response to stakeholder feedback that more time is needed to prepare for enrollment, the May Revision proposes to move the implementation date from January 1, 2013 to March 1, 2013. Enrollment will be phased in throughout the rest of 2013.
- Demonstration Counties - The number of counties proposed for demonstration implementation in 2013 has been reduced from ten to eight. The Administration has suspended work on launching the demonstration in Contra Costa and Sacramento counties for 2013, but intends to include those counties in the second year expansion.
- Mandatory Medi-Cal Managed Care Enrollment - The May Revision limits dual eligible mandatory enrollment in Medi-Cal managed care in 2013 to only the eight counties where the duals demonstration is implemented. Previously, the Coordinated Care Initiative proposed mandatory Medi-Cal managed care for wrap-around Medi-Cal Services in all managed care counties in 2013.
Please find all important information and updates posted to the DHCS Duals website page.
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National Provider Call: Inpatient Rehabilitation Facility Prospective Payment System Coverage Requirements - Register Now!
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Beginning January 1, 2010, all Medicare Fee-For-Service (FFS) inpatient rehabilitation facility (IRF) claims were required to meet new coverage requirements for payment under the IRF prospective payment system (PPS). During this National Provider Call, CMS subject matter experts will provide an overview of the requirements and address questions that providers continue to have as they apply these requirements. Don't miss this opportunity to participate in updated training on the IRF PPS coverage requirements. Target Audience: Medicare FFS providers, IRF providers, Recovery Audit Contractors, and Medicare Administrative Contractors Registration Information: In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls webpage. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. Presentation: The presentation for this call will be posted at least one day in advance on the FFS National Provider Calls webpage. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call. |
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Comments Due June 28 on PMD Prior Authorization Demonstration
| CMS published a proposed information collection request on the power mobility devices prior authorization demonstration in the Federal Register on Tuesday. The 30-day public comment period is open through June 28.
The Office of Management and Budget will take public comments and CMS' responses to them into account when deciding whether or not to approve CMS' request to collect information from providers. Given that CMS has stated that it intends to notify providers at least 30 days prior to beginning the demonstration, the start date is likely to be after August 1, which is another delay from previously announced dates.
Comments and recommendations must be received at the address below, no later than 5:00 p.m. on the closing date:
OMB
Office of Information and Regulatory Affairs
Attention: CMS Desk Officer
Fax Number: (202) 395-6974
Email: OIRA_submission@omb.eop.gov
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SAVE THE DATE
Version 2010 - Are You Ready?
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When: June 20, 2012
Time: 1:00 p.m. - 2:00 p.m. PST Who: Hosted by your Centers for Medicare & Medicaid Services (CMS) Regional Office What: Please join CMS staff for an informative webinar for healthcare providers, clearinghouses and vendors on Version 5010. Version 5010 refers to the standards that HIPAA-covered entities (health plans, health care clearinghouses, and certain health care providers) must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses. All covered entities should have been fully compliant with Version 5010 by January 1, 2012; however, an enforcement delay is in effect until June 30, 2012. In this webinar, CMS will cover: - Current Conversion Statistics
- Final Preparations for 5010/D.0 Cutover
- Operational Concerns
- Future of EDI Communications
- Resources and Contact Information
*Stay tuned for further information on the details of your region's session and registration information.
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