DHCS published a notice of the changes on 5/10/21 and it is reprinted below. CAMPS is reviewing the rate adjustments and is in contact with DHCS. We are not certain when the rates will actually be posted to the fee schedule and claims paid based upon the new rates, but we assume it will be relatively soon.
Reprinted from DHCS:
Temporary Increased COVID-19 Durable Medical Equipment Oxygen and Respiratory Rates
May 10, 2021
Effective for dates of service on or after March 1, 2020 and updated effective January 1, 2021, Durable Medical Equipment (DME) Oxygen and Respiratory rates are temporarily increased due to the ongoing coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE).
Following the declaration of the PHE and national emergency in the United States, the Centers for Medicare & Medicaid Services approved Disaster Relief State Plan Amendment 21-0016 authorizing the Department of Health Care Services (DHCS) to increase the DME Oxygen and Respiratory rates equivalent to 100 percent of the Medicare rate, retroactively effective from March 1, 2020, to the end of the PHE. In addition, the DME Oxygen and Respiratory codes are exempt from the ten percent payment reduction in Welfare and Institutions (W&I) Code section 14105.192, as described in Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan. DHCS updated the DME Oxygen and Respiratory rates effective for dates of service on or after March 1, 2020 and effective January 1, 2021, based on the corresponding Medicare rural rate as provided in the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee Schedule.
Refer to the Medi-Cal Rates page for more information on rate updates.
An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriation and adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.
