The Governor released his proposed budget for 2015-16 on January 9th. Though there is additional Medi-Cal funding for the increased caseload due to the ACA expansion he provides no relief to the 10% Medi-Cal provider rate reductions or the risk of claw back of the 10% retroactive to June 2011 that will impact some providers like DME and medical suppliers. There is still no indication when the claw back would begin but the threat remains. The Legislature will now begin to develop its own version of the budget and that process will begin in earnest in March and April. The state should end the current fiscal year in June with an even larger budget surplus than estimated last year.
There continues to be broad support in the Legislature to undoing the damage that has been done to Medi-Cal providers. We are likely to see legislation and more likely budget action on the issue but the impediment is clearly the Governor, who is unwilling to expend additional resources without a clear demonstration of patient access issues. Medi-Cal Primary Care physician rates, which were increased slightly last year, are about to be cut by 60 percent.
CAMPS will continue to push for relief and will provide direction to you in terms of grassroots contacts for specific state legislators.
New Board of Pharmacy Requirements on Prescription Labels
The Board of Pharmacy has finalized and published changes to their current regulations on prescription drug labels. Some CAMPS members who are pharmacies may dispense some medications. The Board of Pharmacy's changes amend Title 16 California Code of Regulations Section 1707.5 which require that all pharmacies must print patient prescription labels in 12-point sans serif font size or larger. Previous regulations required pharmacies to use a 10-point font. This requirement will go into effect on April 1, 2015.
Please Share Your Experience/Reaction to Increasing CPAP Compliance Demands
An increasing number of health plans and insurers are now requiring providers to download PAP compliance data every three months for the first year of use in order to be reimbursed for CPAP units. That may then need to be done annually to be reimbursed for supplies. There are significant costs associated with these downloads that are included in the rental or purchase and not part of the original cost calculation. Costs like:
- Purchasing more costly PAP with memories
- Buying modems & issuing modems
- Retrieving modems
- Buying extra data cards
- Increased employee costs for: (1) time consuming interactions with patients to instruct them on how to write the memory to the data card; (2) acquiring/exchanging the data cards; (3) downloading the reports (frequently by a licensed Respiratory Therapist); and (4) conveying the reports to the insurance company that often claim no receipt.
This began with Medicare but now other payers like Anthem are adopting and expanding the requirements. We would like to hear from you or your payer experience. Send us an email.
