CAMPS was asked to participate in a stakeholder discussion re problems with Competitive Bidding (CB) in California. The meeting was set up by CMS Region IX staff and the CB Ombudsman and included a number of medical and discharge planners from Univ. of Ca. San Francisco Med Ctr., as well as staff from the Ca. Hospital Association. The physicians and staff of UCSF Med. Ctr. expressed great frustration over problems in getting equipment and timely discharge of patients. They indicated that unlike the situation prior to CB a discharge planner has no option to utilize different providers based upon quality and responsiveness. Clearly some of the frustration was misdirected at CB providers who are unable /unwilling to dispense some DME unless the referral source can provide needed documentation to prevent post payment audit recovery. They do not understand the nature or complexity of the medical justification criteria.

 

CMS responded that they had a process for collecting and acting upon referral source and patient complaints and the level of complaints were not high. CAMPS and hospital representatives indicated that those complaint tools are not easily used by elderly patients and are not a true barometer of patient/referral source dissatisfaction. We also pointed to the likely disastrous impact of the application of the CB rates to rural areas beginning on July 1st. Federal legislative efforts to delay that implementation are still in process and may not happen soon enough to forestall the impact.

 

• Delays the second cut for HME items in non-bid areas until September 30, 2016. 
• Instructs the Dept. of Health & Human Services to study the impact of bidding-derived payment adjustments on suppliers and beneficiary access by September of 2016 (exact date not specified). 
• Includes other non-HME-specific Medicare- and Medicare-related bills that have previously passed the House, as well as other unrelated items as noted in this bill summary.

A Senate version of the legislation (S. 2736), passed on June 24, would delay the cuts through June 2017.

"The House and Senate have both passed legislation instructing CMS to delay a new round of deep cuts for rural home medical equipment providers to make sure these steep reductions aren't causing problems for Medicare beneficiaries," said Tom Ryan, president & CEO of the American Association for Homecare.  "This is a clear signal that Congress understands the potential harm to providers and patients alike in cutting these rates to the bone."

"Now the House and Senate need to complete the process and send a bill to the President," added Ryan.  "With the new rates now going into effect, we need our champions in both the House and Senate to find a way to move forward immediately."

Ryan also urged home medical equipment providers to contact their representatives in both the House and Senate and ask for their help in moving this process towards a successful conclusion.

"With Congress set to adjourn on July 15, there's a real sense of urgency to finding a workable solution by next week," said Ryan.  "If the HME community and Congress can't get rural relief legislation passed, I expect to see more reports of rural providers who are either curtailing their offerings to Medicare beneficiaries, abandoning the program altogether, or going out of business.  As a result, seniors and people with disabilities, as well as the people who care for them, are going to find it harder to get the products and services they depend on."

We have seen and heard from several members re the notice in the last Medi-Cal Provider Bulletin regarding reductions to unspecified DME codes that exceed 80% of the Medicare rate. We made several inquiries last week to gain specific information but have not yet received a response. We will provide more information as soon as it is available. We have pasted below the notice from the Bulletin. The outstanding issue of the Medi-Cal claw back of the 10% provider rate reduction for the retroactive period has still not occurred, but it will be implemented. The latest intel we have it that it would begin in August and be done on a 24 month period. More on that as well when information becomes available.

Effective retroactively for dates of service on or after October 1, 2015, reimbursement rates for selected Durable Medical Equipment (DME) HCPCS procedure codes are updated. Welfare and Institutions Code (W&I Code), Section 14105.48 requires Medi-Cal rates for DME codes to not exceed 80 percent of the corresponding Medicare rate, or 100 percent of the corresponding Medicare rate regarding complex rehabilitative technology codes.

These changes will be reflected in the provider manual in a future Medi-Cal Update.
 

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Under current law the current CCS carve out from Medi-Cal Managed Care enrollment would end on 12/31/16.  SB 586 (Hernandez) has passed the Senate and last week passed the Assembly Health Committee on a vote of 18-0 and now moves to the Appropriations Committee.

SB 586 basically extends the sunset on the carve out to 2025 except for those CCS kids already covered under contracts in County Operated Health Systems including San Mateo, Santa Barbara, Yolo, Solano, Marin and Napa.  It also allows DHCS to implement the Whole Child Model (WCM) no earlier than 7/1/17.

The WCM would result in CCS eligibles enrolling in Managed Care plans with very specific criteria, assessments, and benchmarks. Prior versions of SB 586 would have allowed the WCM to be implemented in a limited number of counties. Recent amendments which are extensive and still being drafted shift that process to requiring DHCS to specifically approve a specific plan based upon significant documentation of compliance with existing CCS policies, input and signoff from providers in those counties and a family resource advisory council. The bill does not contain a specific number of counties or plans.

We will update members in August when the bill must pass the Legislature and be sent to the Governor.

Thursday, October 6th, 2016

9:00am - 4:30pm

Long Beach Yacht Club
6201 Appian Way
Long Beach, CA 90803

 

Registration includes continental breakfast, lunch, networking and important updates on Medicare, Medi-Cal, CCS Redesign, Managed Care and State Legislation. Come join 100+ of your medical product supply colleagues whether you are a member of CAMPS or just in the industry.

Online registration opening soon. Email [email protected] for more information.