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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.
CAMPS continues to fight against the adoption of this proposed SPA. We have sent letters to CMS Regional Office and DHCS to point out the errors in their assessment of possible impact on Medi-Cal patient access to DME. The DHCS access analysis stated that there were currently about 1,100 enrolled DME providers and if only 50% of those providers continued to service Medi-Cal Fee for service patients they would maintain an acceptable ratio of providers to patients. That analysis does not consider several important factors;
- No indication that these providers are currently accepting Medi-Cal patients or whether the providers offer limited services, i.e. rehab or 02 only or full service DME.
- In some areas of Ca. there are just a few, in some counties only 1, licensed HMDRFs in the region.
- How can you assess access when the new rates are not yet in place, many providers are unaware, and some the DME rental rates will decline by 50-60%.
It is still unknown when CMS will take action on the SPA and no real timeframes for when the other actions will be triggered; new Medi-Cal rates are implemented, when the claw back to 1/1/19 will occur. It is important to remember that if this SPA is approved, the rates you are currently receiving under fee for service Medi-Cal are not correct and overpayments will be recouped.
We encourage you to educate your patients, referral sources, state legislators, and support CAMPS. There are resources available at www.campsone.org
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CAMPS 6th Annual Fall Conference
REGISTRATION NOW OPEN!
Thursday, September 5, 2019
Long Beach Yacht Club
6201 E Appian Way, Long Beach, CA 90803
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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