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California HME Update

State Budget/ Medi-Cal Rates/ Act Now

CAMPS has advocated in the Assembly and Senate Budget Sub-committee process for statutory changes on how Medi-Cal reimburses for DME. Current law requires that Medi-Cal reimburse DME items at either 80% of the comparable Medicare rate for most DME and 100% of Medicare for custom rehab equipment and accessories. In addition, due to provider rate reductions from 2011 those rates were further reduced by 10%.

DHCS has filed a State Plan Amendment that would change reimbursement to be 80 or 100% of the Medicare non-rural rates that would utilize the much lower Medicare CB rates. If the SPA were to be approved by CMS later this year it would then be applied retroactively to 1/1/19. We have support for our changes from the Ca. Children's Hospital Assoc., the Children's Specialty Care Coalition, Western Center on Law and Poverty and others. Those requests were;

  1. Amend Welfare and Code section 14105.48 to establish that all categories of DME be reimbursed at 100% of the lowest maximum allowance for California for Medicare. In the case of DME where the rate is established under the Medicare Competitive bidding program the rate shall be based on the average rate between rural and non-rural areas. DHCS in its State Plan Amendment filed and pending approval the cost savings by using the current 80% of Medicare was $3.7 Million.
     
  2. Require the Medi-Cal program when reimbursing for custom rehabilitation equipment when reimbursing using 100% of the Medicare rate to recognize the KU modifier and increase reimbursement according to the applicable Medicare rate. We are not able to determine the cost impact but assume it is small and less than $ 3 million.
     
  3. Repeal the existing 10% Provider rate cut.
Over the next week the Budget Conference Committee will finalize the budget to be approved by both Houses. It is expected that the process will be concluded by June 7th.
 
Please contact the 10 members of the Conference Committee by phone/ email/ letter-
 
Ask them to support the Assembly version of Health and Human Services Issue # 9- Prop. 56 Supplemental Medi-Cal Provider Rates. The Assembly version would eliminate the current 10% provider rate cut and increase the rate for DME from 80-100% of the Medicare rate.  
 
We will need all our members to contact those legislators to urge them to support the Assembly version and our Medi-Cal specific issues. Go to www.campsone.org where you can find the names and contact info for the 10 legislators and a sample template letter. It is crunch time and DHCS and the Administration continue to oppose our suggested changes.
 
Please encourage any of your CCS patients/ families/ caregivers to sign up at the Family Voices link to encourage the DME reforms. Family Voices is an advocacy group for CCS families and supports our requests. Here is the link and it's easy to use
 





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