HHP has previously reported that the Department of Health Care Services (DHCS) scheduled a stakeholders meeting to receive comments on its second reimbursement policy proposal, which took place earlier today.  The hearing healthcare profession was well represented both in person and by phone.  Participants included hearing aid dispensers and audiologist providers, Children's Hospital Audiologists, HHP leadership, California Audiologists Association (CAA) leadership, representatives from a Fee for Service Rights advocates group, multiple lobbyists, and two key legislative staffers.

During the meeting the Department indicated multiple times their intent to be budget neutral and hold the providers whole, that the mark up was intended to be 67% and that they had done a review of claim and came up with this average.  They also shared that they have pulled 100 claims additional, and will review the 150 for an average assessment.  They still believe everyone does not get a rebate or discount.

The providers prepared statistical information to support that the revised policy proposal would not cover their costs. Several examples were also provided to point out that patient access has already been impacted.  Lastly, there was discussion about the need to potentially have a slightly higher markup when dispensing hearing aids to children.   The Department asked for additional feedback on access for children and the cost for purchasing single verses two units.

The meeting concluded with a work group being formed to reach an agreeable reimbursement methodology.  The Department assured that it will not implement a new policy until an agreeable solution is reached.   HHP as well as CAA will be well represented in this work group. 

HHP will continue to monitor the development of this issue and keep members informed of any new developments.

Medi-Cal Claims Processing Update  

As a result of the Department of Health Care Services attempt to implement a policy change that has since been delayed due to industry pressure, some providers experienced reduced payments on hearing aid claims submitted since January 15.  As HHP previously reported, the policy change has not been implemented (see more details below). 

The Department reported at today's stakeholders meeting that as of March 27 all claims should be reimbursing at the existing (Old) policy rates.  John Wunderlich at DHCS indicated that claims reimbursed at a reduced amount should receive an erroneous payment correction (EPC); however, he could not confirm that EPCs would be forthcoming.  Therefore, he encouraged providers that have experienced payment reductions for dates of service on or after January 15 contact him directly at Jonathan.Wunderlich@dhcs.ca.gov. 

It was further reported that the provider manual has been corrected to reflect the current "Old" policy.