CAMPS sent a letter to the Chair of the Assembly Budget Sub-Committee regarding the impact of Medi-Cal fully implementing the Medicare Competitive Bid rates for DME reimbursement. Currently Medi-Cal is using 80% of Medicare for DME and 100% of Medicare for wheelchairs using Medicare rates as of 1/1/16. DHCS has indicated that they will transition to 7/1/16 rates at some point. See our letter here.

 

The issue of Medi-Cal DME rates was added to the agenda of the Sub-Committee for its hearing on 3/13 and CAMPS Executive Director made a presentation to the Committee on the issue of Medicare CB impact and the further reductions via the 10% provider rate cut and pending claw back. The full impact of Medicare CB rates using 80% are not sustainable. He asked for two statutory changes; (1) makes the Medi-Cal rates for all DME at 100% of Medicare, currently 80% for most DME and 100% for chairs, and (2) specifies that the Medicare rates are those in effect as of 1/1/16, i.e. the rates that Medi-Cal is currently using.

 

The Committee took no action on the CAMPS proposal or those from several other provider groups asking for rate cut relief. The Sub-Committee will likely take these issues up again after the release of the Governor's May Revise in early May.

CAMPS is sponsoring AB 1387 (Arambula) which would exempt an HMDRF from annual inspections if they are accredited by an accrediting body approved by CMS/ Medicare. Upon initial licensure a HMDRF would be inspected but after that would only be inspected based upon a complaint to CDPH. Non- accredited HMDRFs would continue to be subject to annual inspections.

 

CAMPS sponsored legislation to create HMDRF licensing in 2000 to allow non-pharmacies to dispense legend stamped or dangerous devices. The requirements for compliance have largely been developed by CDPH staff and inspectors with few elements detailed in regulation or statute. In 2006 Medicare established a requirement that all providers of DME and medical supplies must be accredited by one of 10 recognized accrediting bodies. The accreditation process is a rigorous with a procedure and process driven program to assure both quality and patient protections. It is a more extensive oversight process than state inspections.

 

In addition under current law an HMDRF located outside California that provides services to California residents is required to be licensed but is not subject to initial or annual inspections.  There are approximately 1,100 HMDRFs in California and over 300 out of state HMDRFs. In state HMDRFs are subject to an additional burden and uncertain state requirements while out of state HMDRFs are not held to the same standards. SB 1387 has been referred to the Assembly Health Committee and will likely be heard in April.