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Update from Sacramento
The Legislature adjourned last week for the year and will return in January. The Special Session on Medi-Cal called by the Governor had some proposals introduced but nothing sent to the Governor. The Special Session was called to deal with Medi-Cal funding, the Managed Care Organization (MCO) tax, Medi-Cal provider rate cuts, and funding for developmentally disabled services. The current MCO tax is required to be made more broad based, i.e. not just Medi-Cal managed care organization, under order by CMS and the state has until July 2016 to do so or risk the loss of $1.1B in Medi-Cal funds. There were active discussions between the Administration and the plans to develop a formula that did not unfairly impact plans using tiered rates based upon size and lives. At the end of the day the plans opposed any of the vehicles and Republicans, some of whose votes would be needed to get to the required 2/3rds vote for passage, were unwilling to adopt a broader new tax on health care premiums. The fact that the current MCO tax structure can remain until July 2016 also makes it unlikely that action would occur now.
A number of proposals were introduced to increase the existing cigarette tax by $1-2 per pack to provide funding to raise Medi-Cal provider rates were passed by Committee but ultimately not voted on the floor of either House. Republicans agree with need to raise provider rates but with a large budget surplus this past year and more for the current year why not fund it in the budget and not seek higher taxes. The Special Session technically does not end but it's not likely the Legislature will reconvene outside of the regular session that won't convene until January.
The Medi-Cal claw back of the 10% cut retroactive to June 2011 has begun for pharmacy providers with the large chain providers getting reams of RADs to review. There are exemptions for some drugs and this does not apply to DME or medical supplies, except for enteral formula and diabetic test strips. We are not sure when non-chain pharmacy providers will get there letters but the process has begun for the larger pharmacies. We have no indication as of yet when the recoupment will begin for DME and medical supplies but don't assume it would begin before at least end of year.
The Medi-Cal Duals demonstration program has now begun in all of the seven targeted counties. The opt out rate in these counties has remained very high. Beneficiaries can opt out of the Medicare portion and not transition to Medi-Cal managed care for both their Medicare and Medi-Cal coverage. They have no option for the Medi-Cal portion. A report this morning showed the opt out rate in Orange County, where Cal Optima is the only plan, was 66% in August. In LA county the opt out rate has been as high as 61%.
The ICD-10 transition is still on target to begin on October 1st. Medi-Cal has published some draft data on the ICD-10 codes that will now qualify for medical necessity for a variety of medical supplies. They will be updated and assumed finalized before 10/1/15. Medi-Cal has announced that they will be using an internal crosswalk in the short term to convert ICD-10 codes to ICD-9 codes. Most provider groups are concerned that there may be payment delays with Medicare and Medi-Cal when the switch is flipped.
The CCS Redesign project is continuing with the provider community still urging the Administration to continue the current carve out of CCS beneficiaries from Medi-Cal managed care. AB 187 ( Bonta) would extend the current carve-out from January 2016 to January 2017. AB 187 is on the Governor's desk for signature. There are about 175,000 children in the CCS program and about 90% are also Medi-Ca eligible. The Administration has now proposed a longer transition period and a shift to Medi-Cal managed care in a limited number of counties. That concept has also not been warmly received by the patient or provider community. We will know more later this year on what changes if any occur and the timing.
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2nd Annual Fall Conference
Long Beach Yacht Club
6201 E Appian Way, Long Beach, CA 90803
Rescheduled: November 5, 2015
CAMPS Fall Conference - Speaker Highlight:
"Inspections at Your Facility"
Susean Nichols,
Millennium Management Services, LLC
Part 1 will prepare you with Home Medical Device Retailer (HMDR) licensing program guidelines from CDPH so that your facility can pass inspection. Part 2 to focus on Accreditation updates and preparation. Both topics are important with new ventilator issues and Medicare, and the accreditation organizations. Length: 90 minutes Date: November 5th, 2015 Location: Long Beach Yacht Club, 2nd Floor Dining Room
Contact events@campsone.org with questions. (916) 443-2115 ext. 105 for Meeting Manager, Lauren Stoddard. |
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One Capitol Mall, Suite 800
Sacramento, CA 95814 t: (916) 443-2115 f: (916) 444-7462 |
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