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CAMPS Continues to Push for Relief of Possible Use of Medicare Rates for
Medi-Cal
CAMPS continues to advocate to limit the use of Medicare Competitive Bid rates for Medi-Cal 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.
We are now awaiting the Governor's May Revise on the Budget.The Budget sub-committees will complete their work and adopt their version of the budget. CAMPS has proposed 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.
We will keep you informed of our progress. A state budget must be adopted and sent to the Governor by June 15th.
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CAMPS Sponsors Bill to Reduce HMDRF Inspections for Accredited Providers Moves to Assembly Floor
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.
When the bill passed the Assembly Health Committee we accepted amendments that would do the following, (1) the licensee must be accredited every three years, (2) licensee is subject to unannounced on-site midcycle inspection by the accrediting organization, and (3) the accrediting organization must inform CDPH within 30 days if the licensee loses their accreditation status.
We believe that AB 1387 will level the playing field for in-state HMDRFs and out of state licensed HMDRFs the latter of which are not subject to initial or annual inspections. There are approximately 1,100 HMDRFs in California and over 300 out of state HMDRFs. AB 1387 has passed both the Assembly Health Committee and Assembly Appropriations and is now on Consent on the Assembly Floor. AB 1387 will then move to the Senate.
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Medi-Cal Claw Back of 10%
There has been no announcement of implementation of the 10% provider rate claw back for DME and medical supplies for the period July 1, 2011 to October 2014. DHCS will provide 60 days notice of their intent to begin the claw back and no noticed has yet been provided.
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Medi-Cal Ordering/
Rendering Provider Requirement
CAMPS continues to participate in a DHCS Stakeholder Group on implementation of the federal requirement for ordering/rendering providers. Medi-Cal is required to verify that any physician or other practitioner who orders services for a Medi-Cal enrollee is either enrolled in Medi-Cal or Medicare and has valid Type 1 or individual NPI number. When implemented a DME provider who bills for services ordered by a practitioner without a valid NPI will have that claim denied. Medi-Cal has been providing sample denial codes to DME providers to highlight a prescriber who is not properly enrolled but has not been denying claims, i.e. informational only.
DHCS indicates that the first provider type that will impacted is pharmacy for any service/good billed on a pharmacy claim form. It may begin in late June but still will be informational with no denial of service. There is no announced timeline for DME or medical supplies and we will notify members as we learn more. DHCS is also working to establish a central portal where providers can verify provider Medicare enrollment via PECOS.
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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