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Medi-Cal DME Rate Cuts- Urgent Call to Action
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Background
The State is planning to lower the Medi-Cal fee-for-service rates for certain DME items. Under the 21st Century Cures Act, California will not be eligible to receive federal match dollars if it pays more than the prevailing Medicare rates for DME. DHCS is currently drafting a State Plan Amendment (SPA) for CMS. Medi-Cal will pay either 80% or 100% of the Medicare rates for DME using the non-rural competitive bid rates effective January 1, 2019. Specifically, DME rates except for wheelchairs, wheelchair accessories and speech-generating devices & related accessories will not exceed 80% of the non-rural Medicare DMEPOS fee schedule. Rates for wheelchairs, wheelchair accessories and speech-generating devices & related accessories will not exceed 100% of the non-rural Medicare DMEPOS fee schedule. The proposed SPA is subject to CMS approval. DHCS intends to implement retroactive rate adjustments this fall.
Affected DME
The rate reductions apply to certain Medicare covered DME items that are also covered by fee-for-service Medi-Cal.
For the most part these are DME items identified by HCPCS "E" series and "K" series codes. Those codes include items like canes, crutches, commodes, hospital beds, oxygen concentrators, wheelchairs, power mobility devices and more. It does not apply to medical supplies, orthotics or prosthetics, nor does it apply to items for which Medi-Cal is not the primary payer.
Impact to DME Providers
The impact of these rate reductions to Medi-Cal DME providers will be devastating. Below is a comparison of the Medi-Cal rates on just a few affected codes:
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HCPCS Code
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Description
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2018 MCL Rate
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2019 MCL Rate
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E1390
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Concentrator
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$144.74
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$55.19
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E0470
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Bi-Pap
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$188.51
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$83.06
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K0001
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Standard Wheelchair
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$47.30
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$17.46
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CAMPS Response
CAMPS submitted a formal letter of opposition to DHCS on January 19, 2019. Now we are working with AAHomecare, VGM and others to mitigate these cuts. Our best avenue for relief is through the Legislative budget process. CAMPS has about 60 days to effectively lobby key state lawmakers.
CAMPS Call to Action
CAMPS needs the membership to get involved. Here are 3 ways to help:
- DONATE: CAMPS needs immediate funds for lobbying and public relations. These efforts are expensive and your donations are tax deductible.
- CONTACT: CAMPS needs providers to contact some key State representatives. Tell them how these rate cuts will negatively impact patient access and your business.
- Assembly Budget Chair Eloise Gomez Reyes (D-Fontana / San Bernardino) 916-319-2047
- Senate Budget Chair Richard Pan (D-Sacramento) 916-651-4006
- Senate Budget Member Melissa Hurtado (D-Hanford) 916-651-4014
- Senate Budget Member Jeff Stone (R-Palm Desert / La Quinta) 916-651-4028
3.ACTIVATE: CAMPS needs providers to get the word out. Inform your patients and referral sources. Tell your friendly DME competitors and manufacturers to get involved too.
The fate of the California DME industry is at stake here and there is not much time to act. Call Bob Achermann at CAMPS today for more information at 916-443-2115 or email
BAchermann@amgroup.us
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Sincerely,
David Fein
CAMPS President
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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