Medi-Cal SPA to Increase Reimbursement Rates for Respiratory Equipment and Supplies Approved
We are pleased to report that on March 26th CMS has approved the Medi-Cal State Plan Amendment (SPA) to increase the rates of reimbursement for fee for service Medi-Cal for respiratory equipment and supplies. 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. We were very pleased to be informed that DHCS was taking immediate steps to increase FFS reimbursement rates for DME respiratory equipment and supplies. They took the following actions:
They filed a waiver request on February 2, 2021 with CMS to increase the Medi-Cal Fee for services reimbursement rates 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 still take time to get implement to change rates in their payment system and then do an Electronic Payment Correction (EPC) to reprocess prior claims paid going back to March 1, 2020. We will alert you when the rates are changed, which typically happens on the 15th of the month but we are not certain it can be accomplished by April 15th. The EPC will not occur until much later and again we will alert our members when it is announced.
This is FFS only but we have heard that at LA Care had notified some providers of a re-coup for over payments on 02 concentrator rentals from May to June of 2020. CAMPS reached out to LA Care and informed them of the pending SPA that would raise that rental rate retroactively. We have been told that this effort has been stopped. It may also have been initiated in the Blue Shield Promise program. We will be confirming and if necessary reaching out to Blue Shield.
This is needed relief to the DME provider community and comes from the hard work of dedicated CAMPS leadership. Once all the details are confirmed CAMPS will host a webinar for members on the changes and timing.
