CAMPS Events & Education

FIND YOUR FEDERAL REPRESENTATIVE HERE

California HME Update

CAMPS Successful In First Stage of Changes to Medi-Cal DME Reimbursement

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. You can go to www.campsone.org to see all the details and guide you in reaching out to key legislators to ask them to provide our requested relief. Other organizations like the Ca. Children's Hospital Assoc., the Children's Specialty Care Coalition, Western Center on Law and Poverty are in support of our budget change requests. 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.
 
This week the Assembly Budget Sub did include in its final report (1) elimination of the 10% provider rate cut, and (2) Elimination of the current 80% of Medicare for DME and make all DME at 100%. It is really placeholder language and not very specific as to defining the Medicare rate, i.e., non-rural rates, or use of the KU modifier on custom rehab. That was our request but the description of the action is more a use of Prop 56 funds, which was the increase in tobacco taxes to help increase Medi-Cal provider rates. It also includes funds to increase reimbursement rates for breast pumps.

The Senate Budget sub did not adopt either of our requests. They did not adopt a change to restore the remaining optional benefits that had not yet been restored, which includes incontinence creams and washes.

Both full budget committees will now adopt their own version of the budget. Each House will pass their own version and a Conference Committee comprised of members from both the Senate and Assembly will be selected later next week. The Conference Committee will then meet the following week and begin to resolve the differences between the two versions, which includes our issues, and fashion the final version of the Conference Committee budget. We will not know who those Conference Committee members are until next week typically there are 6 members.
 
We will need all our members to contact those legislators to urge them to support the Assembly version and our Medi-Cal specific issues. We will post that information and messaging next week when more information is known. It will be found at www.campsone.org.
 
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
 




One Capitol Mall, Suite 800
Sacramento, CA 95814 
t: (916) 443-2115 
f: (916) 444-7462