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California HME Update
Bills to Prohibit Retroactive Medi-Cal Rate Reduction Pass First Committees

The Legislature adopted a 10% Medi-Cal provider rate reduction that was to have taken effect on June 1, 2011 as part of the budget deal to close the then state budget deficit for 2011-12. Due to delays in CMS approval and a subsequent Federal  Court injunction that rate cut was never implemented for DME or medical supplies. CAMPS has been part of a coalition that has funded the legal effort to enjoin the cut.  Earlier this year a panel for the Ninth Circuit Court of Appeals reversed the ruling and DHCS has  indicated their intent to retroactively recoup that 10% cut back to June 1, 2011. They would do so by cutting current provider rates by 10% and then also taking an additional 5% of current payments each month until the individual provider payments have been recovered.

There is a pending request to have the entire Ninth Circuit Court of Appeals hear an appeal of the 3 judge ruling and pending a decision on whether to grant that hearing DHCS will not yet take any action.  A decision could come any day. In the meantime, a provider coalition is pushing two bills in the Legislature to block any retroactive "clawback" of the 10% both in fee for service payments or in reductions to Medi-Cal managed care plan capitation payments. SB 640 (Lara) passed the Senate Health Committee and AB 900 (Alejo) passed the Assembly Health Committee this week. The specific amount of the retroactive take back for DME and supplies would be slightly over $37 million.   If passed these bills would need to be signed by the Governor or accomplished in the current budget process to become law. The Governor has been reluctant to undo any of the prior budget cuts that were used to balance the budget. His current budget proposal for 2013-14 still contains savings from the 10% cut. CAMPS supports this effort and will keep you informed of developments. If you have not contributed to the CAMPS legal fund please consider doing so. Our legal costs as part of the coalition are continuing. You can make a contribution by going to the CAMPS website at www.campsone.org.
 
CAMPS Supported Bill on Medi-Cal Custom Rehab Technology Continues Progress in Assembly

CAMPS supports AB 582 (Chesbro) dealing with custom rehabilitation technology under the Medi-Cal program. AB 582 passed the Assembly Health Committee on a vote of 19-0 and is also supported by a variety of patient advocacy groups. We support AB 582 in making the following changes to the custom rehab technology benefit under the Medi-Cal program:

 

               * Establish custom rehab technology (CRT) as a separate benefit from other types of DME. This will allow a better focus on the provision of equipment to address the physical, cognitive and functional needs of the patient. Patients often include pediatric patients who may also be CCS eligible and those with specific types of medical conditions like Muscular Dystrophy, Cerebral Palsy, and Spina Bifida.

 

               * Require that providers of CRT have staff that possesses specific training and certifications related to fitting and evaluation of complex equipment. It strengthens an existing requirement under Medi-Cal. It would also require that these providers offer service and maintenance of the CRT that they dispense to patients. This will ensure greater access by patients to these necessary services. This is one of the common complaints by Medi-Cal CRT users that they have difficulty in accessing service providers.

 

               * Would make a clarification of the current methodology of the Upper Billing Limit as applied to CRT. It would clarify that the existing provision intended to recognize the unique labor costs associated with providing CRT is more easily accounted for in the provider record. It does not change the calculation of the Medi-Cal reimbursement amount.

 

AB 582 will be heard next week in the Assembly Appropriations Committee.

 

 

 




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