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January 9, 2014  



Governor's Budget Proposal Has Good News
on Medi-Cal Claw Back of 10%


The Governor's budget proposal for 2014-15 got leaked a day early but has some very good news on the potential claw back or recoupment of prior payments to Medi-Cal physician providers re the 10% rate cut. He is proposing to not take the money back on the retroactive basis to June 1, 2011 which would be a major relief for all physicians. This proposal has to go through the budget process over the next 5 months but the Governor was the major impediment to efforts last year in the Legislature to stop the retroactivity. The elimination is for pathologists as physicians but does not at this point appear to apply to clinical lab payments. It is still possible that the relief could be expanded and CSP will advocate for that expansion. Since the  Medi-Cal fee schedule for clinical labs is still undergoing review for change pursuant to a 2011-12 budget requirement that may be difficult. The results of that effort have yet to be finalized. We will keep you informed.


This doesn't stop the implementation of the 10% reduction for new claims as of 1/9/14 which has begun. It is still possible that legislative or budget action could end that at some point, but nothing definitive as of now. The 10% reduction applies to Medi-Cal fee for service payments. The Medi-Cal Managed Care plans that cover the majority of Medi-Cal beneficiaries had their capitation rates adjusted last October "on an actuarially equivalent basis" to reflect the 10% but exempted physician specialty services like pathology. CSP has verified that the PC of those services will not be reduced but it is less clear on the TC only component from the DHCS directive. Still seeking clarification and if pathology groups can let us know what if any changes they have seen in Medi-Cal managed care payments it would be helpful.


CMA Info on the New
California Health Care Exchange 


The CMA has just made available a brief paper on issues for physician groups with the new Covered California exchange program. It focuses on physician groups verifying whether they are part of any of the plan networks, accuracy of information, and how to make contact with those plans to make corrections. If you are a CMA member you also have access to additional resources. Here is a link to that brief background paper.

California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462