Last week a request for a preliminary injunction to block implementation of Cal MediConnect, the enrollment of dual eligibles in Medi-Cal managed care plans, was filed in Sacramento Superior Court. The suit was brought by the L.A. County Medical Association, three independent living centers, and an individual physician alleging that the passive enrollment process is misleading and that these frail and elderly patients have been harmed by a lack of preparation by the state for implementation. The suit points out a lack of adequate provider networks, plans that have received low performance scores or financial solvency issues. The suit alleges that this passive enrollment process may cause some patients to be unable to see their physician or other provider.
Passive enrollment has begun in five counties: San Mateo in April; Riverside, San Bernardino and San Diego in May; and L.A. County on July 1st. To date there have been about 26,000 duals enrolled in L.A County either actively or passively. Since the lawsuit requests injunctive relief it should get prompt scheduling. We will keep you informed on future developments.
Noridian DME Education will be in Los Angeles and Riverside, CA on 9/23 and 9/25
The event will consist of a presentation with break-out sessions to discuss each section.
Agenda:
- Intake Process
- Preliminary and Written Orders
- Certificate of Medical Necessity and DME Information Form
- Medical Records
- Continued Use and Continued Need
- Advance Beneficiary Notice of Noncoverage
- Proof of Delivery
- Beneficiary Authorization / Signature on File
- Comprehensive Error Rate Testing
The events will take place at the following locations:
Tuesday 9/23 from 8:30 a.m. to 4:30 p.m.
Embassy Suites Los Angeles - International Airport/North
9801 Airport Blvd.
Los Angeles, CA 99045
(310) 215-1000
Thursday 9/25 from 8:30 a.m. to 4:30 p.m.
Marriott Riverside at the Convention Center
3400 Market Street
Riverside, CA 92501
(951) 784-8000
Attendees must preregister. To register, click here
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Federal Court Decision Opens Four-Day Window to Present Claims for Losses Suffered in Round 1 DMEPOS Competitive Bidding Program
Dear DME Supplier:
We invite you to attend an informational webinar concerning a decision last week issued by the Federal Claims Court. As you may or may not know, on June 30, 2014, the United States Court of Federal Claims ("Court") granted a DME provider's ("Plaintiff") Motion for Summary Judgment against the Government (on behalf of CMS) for breach of contract stemming from the Round 1 DMEPOS Competitive Bidding Program ("CBP").
According to the pleadings, on May 21, 2008, CMS announced the DME contract suppliers that won a contract under the Round 1 CBP. The Plaintiff was selected as a contract supplier for 9 of the 10 competitive bidding areas for several product categories. On June 20, 2008, Plaintiff and CMS signed a contract evidencing the award of the bid. On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008 ("MIPPA"), which terminated the contracts awarded to all Round 1 CBP winners, including Plaintiff. In addition, MIPPA provided that CMS would re-conduct the Round 1 bidding (to be called "Round 1 Rebid") in 2009. Between the date the Round 1 CBP winners were announced (May 21) and the date MIPPA was enacted (July 15), the Plaintiff, relying upon its being awarded its contract, bought several trucks, opened numerous offices, and hired additional employees, in anticipation of the increased number of referrals it would obtain and patients it would serve under Round 1 CBP. After the Government later terminated the contract with Plaintiff, Plaintiff filed suit.
In granting the Plaintiff's Motion for Summary Judgment, the Court held that the Government breached its contract and owes damages to Plaintiff. Those damages have not yet been determined and still must be proven, but may include the cost for ramping up as well as anticipated lost profits.
We will be hosting a telephone conference on Wednesday, July 9, 2014, at 2 pm CDT to discuss this case and the impact it may have on Round 1 CBP winners.
IF YOU ARE INTERESTED IN JOINING THE CONFERENCE, PLEASE RESPOND TO THE EMAIL BELOW. A CONFERENCE NUMBER AND PASSWORD WILL BE EMAILED TO YOU.
TIME IS OF THE ESSENCE.
THE STATUTE OF LIMITATIONS TO FILE A CLAIM AGAINST THE GOVERNMENT RUNS NEXT MONDAY, JULY 14, 2014.
