We have been informed that DHCS will be sending 60 day notices to pharmacy providers indicating their intent to begin the claw back of the 10% provider rate reduction for the period 6/1/11 to 2/6/14. The recoupment process would begin no earlier than August 1st. It does include drugs and diabetic test strips but does not include DME or medical supplies. There is no news yet as to when that might begin but expect the same 60 day notice. CAMPS continues to push to elimination of the claw back in the current budget deliberations and will keep you informed of our progress. The Assembly version of the budget does eliminate all retroactive reductions and the issue in now in the two House Conference Committee.

Assembly Bill 97 (Chapter 3, Statutes of 2011) authorizes the Department of Health Care Services (DHCS) to reduce Medi-Cal payments to pharmacies for certain drugs, effective June 1, 2011. During the week of June 1, 2015 (this week) DHCS will send letters to pharmacies advising them of the department's intent to begin recouping funds no less than 60 days from the date of the letter for claims dating from June 1, 2011 to February 6, 2014. The recouped amounts will be subtracted from weekly payments for claims from DHCS to the pharmacies at a rate of approximately 5% of the pharmacy's weekly Medi-Cal check write until the accounts receivable for the recoupment is paid in full. Pending CMS approval, the 10 percent reduction will not be retroactively applied to claims for drugs that the Department of Health Care Services (DHCS) initially identified as being exempt from the 10 percent reduction pursuant to State Plan Amendment 12-014. As has been the DHCS commitment, the purpose of the letters is to provide advance notice of when the recoupment will begin. These 60-day notices WILL NOT contain the total amount due for each pharmacy; that information will be provided just prior to the actual recoupment implementation.

Questions regarding the recoupment should be directed to the Telephone Service Center at 1-800-541-5555, option 1 (for English), option 1 (for Provider), option 5 (for HAP, Family PACT, CHDP, CCS, GHPP, Crossover, LTC and other general billing inquiries), followed by option 6 (for general billing). Please share this email with your associates or network of contacts who may also be interested in receiving this information.