Home Blog A Big Day For California Camps Receives Response Regarding...

A Big Day For California! CAMPS Receives Response Regarding Medi-Cal Reimbursement.

Earlier this year, California HME suppliers received notice from California Medicaid (Medi-Cal) announcing that California would be adopting 80% of the Medicare non-rural reimbursement rates as their fee schedule for most Medi-Cal DME claims. Their intent was to implement the new fee schedule retroactive to Jan. 1, 2019. There were a couple of product categories that were to be paid at 100% of the non-rural Medicare rate; those exceptions were wheelchairs, wheelchair accessories, and speech generating devices and related accessories. This proposed action was being taken by the state in response to direction received by the State Medicaid Director from CMS regarding the CURES Act. The state felt they were out of compliance and needed to make this change, and had submitted their State Plan Amendment (SPA) to CMS outlining these changes.

CAMPS (California Association of Medical Product Suppliers) and VGM immediately took action and reached out to Medi-Cal, providing feedback and examples to help outline why such an action by Medi-Cal would have an extremely negative impact on access to care and network adequacy for Medi-Cal beneficiaries needing DME in the state of California. CAMPS also encouraged California DME suppliers to send letters to DHCS regarding the impact that the proposed DME rate reductions would have on their respective businesses and their ability to care for the patients they serve.

According to a letter received by CAMPS Executive Director, Bob Achermann, and based on the feedback that CAMPS, VGM, and various providers and organizations in California, the state has decided they will not be adopting the fee schedule they originally proposed for Medi-Cal. Rather, they will be implementing a fee schedule based on 80% of the California Medicare rural rates, which will result in higher reimbursement for DME providers than what was originally proposed. As an example, an oxygen concentrator (E1390) was originally going to be reimbursed at $55.19 as initially proposed (80% of the California non-rural Medicare rate of $68.99) but will now be reimbursed at $107.76 (80% of the California rural rate of $134.71). The chart below details a few additional examples of previous, proposed, and now-revised rates.

HCPCS

OLD RATE

Previously Proposed Medi-Cal Rates (without 10 % claw back)

New Proposed 2019 Medi-Cal Rate (Rural Medicare)

E1390

$144.74

$55.19

$107.76

E1392

$41.30

$28.13

$35.45

E0431

$24.34

$12.77

$19.20

E0601

$80.55

$31.51

$59.52

E0562

$23.04

$10.51

$17.90

E0470

$188.51

$83.06

$144.31

E0570

$12.88

$3.80

$9.88

K0001

$47.30

$17.46

$34.32

E0143*

$85.69

$36.97

$64.64

Paul Ondrusek and Craig Douglas of VGM were thrilled to hear this news, because ever since the announcement was initially released by Medi-Cal, California’s DME suppliers have been faced with making a difficult decision regarding their ability to continue to participate with Medi-Cal and provide products and services to that particular patient population. No provider wants to be faced with the thought of being forced to turn their backs on the very patients they were created to serve. These positive and necessary changes will help protect access to critical DME products and services that these patients need. Paul Ondrusek said, “This is a great first step in protecting the access for patents in California. That could not be done with without the CAMPS board and the many other DME providers that got involved, especially Terry Racciato and her team in San Diego. The fight is not over but a good first step.”

While this is indeed a positive change from what was initially proposed, there is still work to be done. Obviously, there is still a reduction in reimbursement that is occurring here, and provider still need to evaluate the new rates and decide whether participation with Medi-Cal is good for their business. Also, in 2011, Assembly Bill 97 was passed, which called for a 10% payment reduction for DME products and services. That payment reduction is still being applied to Medi-Cal claims when they are processed. We continue our efforts to have that 10% reduction halted moving forward now that additional cuts have already been applied to DME products and services. If that is not removed, the reimbursement rates in the far-right column in the chart below will be 10% lower than what is currently shown in the chart above.

We also continue to work towards 1) eliminating the 80% of Medicare for most items of DME and going to 100% of Medicare for all products, 2) getting Medi-Cal to recognize the KU modifier in the appropriate payment of custom rehab equipment, and 3) preventing the new rates from being implemented retroactively to Jan. 1, 2019. The state has submitted a revised SPA to CMS that is not yet approved.

Bob Achermann, Executive Director for CAMPS, thanked those individual CAMPS members who contributed financial resources and staff to make our voices heard. CAMPS needs more support to continue our strong efforts to make sure California patients get the services and equipment they need. Click here to see the announcement from CAMPS.

www.campsone.org/ohana/website/index.cfm?p=80001

John Cassar of Supercare Health said, “This is by far one of the biggest historical wins for CAMPS. I am now truly a believer that collectively, we can all make a difference.”

Photo of John Cassar, Supercare Health; CAMPS Executive Director, Bob Achermann; David Fein, President of CAMPS of Shield Healthcare; Paul Ondrusek of VGM Group

John Cassar, Supercare Health; CAMPS Executive Director, Bob Achermann; David Fein, President of CAMPS of Shield Healthcare; Paul Ondrusek of VGM Group

                                                             

   Photo of Terry Racciato

Terry Racciato of Together We Grow played an instrumental role in rallying DME suppliers to submit letters to Medi-Cal.

VGM applauds the efforts of CAMPS and several individual providers throughout the state of California in their efforts to stand up, speak up, and fight for fair reimbursement rates, and to educate the state’s Medicaid department regarding the pitfalls associated with their proposed reimbursement changes.

Great work!

0 comments