Sacramento, Calif.
The California Association of Medical Product Suppliers (CAMPS) has filed for legal injunction to stop Medicaid reimbursement cuts imposed as part of the state budget.
That budget, passed in July 2003 by then-governor Gray Davis, calls for Medi-Cal, the state's Medicaid program, to pay no more than 80 percent of the Medicare allowable for listed DME, excluding listed wheelchairs and accessories, which are reimbursed at an amount not exceeding 100 percent of the Medicare allowable for California. Unlisted, non-wheelchair items are reimbursed at 20 percent off the manufacturer suggested retail price (MSRP). Unlisted wheelchair parts and accessories are reimbursed at a tiered discount off MSRP, based on the total cost of the chair, up to 20 percent. The unlisted wheelchair parts and accessory code reductions were put in place Jan. 1, while the other cuts were implemented last year.
According to the legal complaint CAMPS filed June 20, “by imposing the rate reductions, California has failed to consider the costs of the supplies and services involved or whether the rate reductions will have an impact on the ability of Medi-Cal beneficiaries to have adequate access to necessary DME and related services.”
When passing the state budget, “nobody determined that 80 percent of the Medicare [allowable] was reasonable; we never saw an analysis,” said CAMPS Executive Director Bob Achermann, explaining that DME providers have significant costs associated with equipment delivery, set-up and maintenance. Providers now “must rethink how they do business, [including] pickup and delivery,” he said. “The repair component has been hit especially hard [since the cuts were implemented],” Achermann continued. “Some dealers are only servicing the equipment they sold. When you provide a custom wheelchair, a lot of fine tuning and adjustment goes on.”
At press time, the state had not filed an answer to the complaint, but Achermann said he expects “substantial movement or resolution” of the issue within 90 days.
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