Medi-Cal Moves to Increase Reimbursement Rates For Respiratory Equipment and Supplies
CAMPS has been urging DHCS to increase the rates of reimbursement for fee for service Medi-Cal for respiratory equipment and supplies since early last year. Our efforts in the state budget process to increase the rates for DME from the current 80% of Medicare to 100% have shown progress with use of Medicare rural rates but never ultimate success. During the current pandemic we have focused our efforts to provide information on the impact of the pandemic on costs and access to respiratory equipment and supplies. That dialogue began in earnest in June 2020.
We shared the December notice that the concentrator rental rate was wrong, would be reduced by 40% and retroactively reduced to 1/1/19. We ramped up our communication with DHCS and had a conference call with DHCS Friday. We are very pleased to report that DHCS is taking immediate steps to increase FFS reimbursement rates for DME respiratory equipment and supplies. They have submitted the following plan to CMS;
They have filed a waiver request (click here to view it) on February 2, 2021 with CMS to increase the reimbursement rate on respiratory equipment and supplies from 80 to 100% of Medicare rural rates effective upon CMS waiver approval effective until the end of the Public Health Epidemic ( PHE), likely end of 2021. Those rates will also be retroactive to the start of the PHE, March 2020.
They will also eliminate the additional 10% cut on respiratory equipment and supplies
We believe that the equipment and supplies include the items enumerated in the Medi-Cal Provider Manual but will share any additional clarification as we learn.
This will all take time to get CMS approval ( should be no more then 2 weeks) , change rates in their payment system ( this can’t occur until CMS approves) and then do an Electronic Payment Correction (EPC )to reprocess prior claims paid going back to March 1, 2020. This will likely take months and we will await official notice of the EPC date. Remember this is FFS only.
This is needed relief to the DME provider community and comes from the hard work of dedicated CAMPS leadership.