DHCS to implement 10 percent Medi-Cal cuts in January 2014 August 15, 2013 Medi-Cal Advocacy, Insurance/Reimbursement, Medi-Cal, Access to Care 0 The Department of Health Care Services (DHCS) today announced that it would begin to implement the 10 percent Medi-Cal physician payment rate reduction on October 1, 2013, for Medi-Cal managed care and on January 9, 2014, for fee for service. DHCS also announced that it would be retroactively implementing the cuts for FFS providers to June 1, 2011, when the law authorizing the cuts went into effect. DHCS said it will recoup a percentage of provider payments to recover overpaid funds during the retroactive period. These retroactive payment recoveries will not occur until after the prospective 10 percent payment reductions are implemented. Additional details were not provided, but assuming the retroactive period ends as of the date the prospective cuts begin, the entire portion for which there would be a "clawback" cut would be June 1, 2011, until January 9, 2014, or over 29 months. Specialty physician services in Medi-Cal managed care will not be subject to a reduction. CMA is working with the state to obtain additional information. In March of 2011, the California Legislature passed and Governor Jerry Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. Shortly thereafter, the California Medical Association filed a lawsuit, CMA et al. v. Douglas et al., to stop the State of California from implementing the 10 percent cut included in the 2011-2012 state budget. In January 2013, a three judge panel of the 9th Circuit Court of Appeals reversed a decision by a district court that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. The Ninth Circuit also vacated the preliminary injunction clearing the way for implementation of these rate reductions. CMA requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied. CMA and the other plaintiffs in the case (the California Hospital Association, California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response), subsequently filed a request with the U.S. Supreme Court for a stay to prevent the cuts going forward. This request was denied a day later. These cuts could not come at a worse time, as California is poised to expand Medi-Cal to 1.4 million more Californians under federal health reform and the demand for physicians is expected to rise. CMA is part of an unprecedented coalition of physicians, dentists, health care workers and hospitals that will continue working to stop the cuts. The coalition, called "We Care for California," includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. Even before the cuts, California's Medi-Cal provider payment rates are some of the lowest in the nation. Low reimbursement rates have driven many of California’s providers from the program. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care. Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmanet.org. Comments are closed.
