JUNE 2021

The California Department of Health Care Services (DHCS) recently announced the details of its annual “check write” delay. DHCS will delay certain payments for two weeks in June so that those claims are paid out of the 2021-2022 fiscal year budget. This check write delay will impact providers who render services through Medi-Cal funded programs.

Medi-Cal fee-for-service payments scheduled with a warrant date of June 17, 2021, will be held until July 2, 2021. Payments to the following programs will be held during this time period:

  • Medi-Cal
    • California Children’s Services (CCS)
    • Child Health and Disability Prevention (CHDP)
    • Family Planning, Access, Care and Treatment (Family PACT)
    • Genetically Handicapped Persons Program (GHPP)
  • Abortion

Medi-Cal funded fee-for-service payments scheduled for June 24, 2021, will be held until July 2, 2021. Payments to the following programs will be held during this time period:

  • Abortion
  • CCS (state-only)
  • GHPP (state-only)
  • Healthy Families
  • Medi-Cal
    • CCS
    • CHDP
    • Family PACT
    • GHPP

Payments made to the Every Woman Counts (EWC) program will be excluded from the hold.

For any additional questions, please feel free to contact me directly at bdocherty@ka-pow.com.

If you miss a day “Under the Dome” – you miss a lot!

 

OCTOBER 2020

In June COPA petitioned CalOptima on behalf of our Orange County Medi-Cal providers who informed us they were getting reimbursed below the current Medi-Cal allowable rate.

Considering how woefully low the existing Medi-Cal reimbursement is for O&P care in California, COPA was surprised to learn CalOptima had been paying Orange County O&P providers only 80% of the state Medi-Cal allowable rate. As a result, the CalOptima reimbursement for the O&P care provided to CalOptima members was only about 40% of the Medicare allowable — 35% lower than the average payment O&P providers across the country receive for treating Medicaid patients.

Due to the COPA petition, CalOptima re-evaluated its provider network and its contracts, and in August approved an increase to O&P provider reimbursement to at least equal the Medi-Cal allowable rates.

This is a small victory but one COPA will parlay at the state level as we anticipate a rough state budget cycle in 2020-2021. Any new infusion of federal relief seems very unlikely in the coming weeks, significantly diminishing hopes that California will restore billions of dollars in cuts the Legislature and Governor Newsom agreed to back in July. Without a stimulus package coming to California from Congress, COPA anticipates potential cuts to O&P Medi-Cal reimbursement rates and/or possible elimination of the O&P Medi-Cal benefit altogether.

Anticipating this fight, COPA has gathered data and information to present to state legislators that compares California Medi-Cal reimbursement rates for O&P care to the Medicaid rates across the country. We are able to demonstrate low-income and vulnerable Medi-Cal patients living in California are losing access to quality O&P care.

Medi-Cal reimbursement rates for O&P appliances in California have not increased in over 25 years. On average, Medi-Cal ONLY REIMBURSES 51% of the prevailing Medicare reimbursement rate. Medicaid reimbursement rates across the county average 75% of the prevailing Medicare allowable.

Considering there have been two decades of compounded increases to the costs for materials, labor, equipment, clinician education, insurance, utilities, and O&P facility rents, the existing Medi-Cal reimbursement often does not even cover the cost of the item, much less the time required for the clinician to evaluate, fit and provide follow-up care to the Medi-Cal beneficiary.

 

For any additional questions, please feel free to contact me directly at bdocherty@ka-pow.com.

If you miss a day “Under the Dome” – you miss a lot!

 

 

JULY 2020

 

Mid-March amid the COVID-19 scare the Legislature abruptly adjourned under duress for the first time in over 150 years. The last time was during the “Great Flood” of 1861-62 when Sacramento was completely underwater. In fact, then Governor-Elect Leland Stanford had to rowboat his way to the Capitol for his inauguration in January 1862.

Prior to heading back to their districts to shelter-in-place the Legislature swiftly passed an appropriation giving Governor Gavin Newsom a $1.1 billion blank check for a myriad of COVID-19 crisis relief efforts. Subsequently, the governor also drained a “rainy day” emergency response fund totaling $1.3 billion. However, thanks to former Governor Jerry Brown and his fiscal steadfastness, California still enjoys an approximate total “rainy day” fund of $17.5 billion.

Originally scheduled to return to Sacramento after their Spring Recess on April 13, the new return date is now May 4. That new start date may also be overly optimistic. Even if the Legislature reconvenes on that date, most staff will still be working remotely. Older members (i.e. 65+) may be excused and various other travel arrangements will need to be worked out. While the Senate has committed to establishing remote voting, the Assembly has encountered constitutional challenges with that concept and is devising various alternatives. The only two constitutional deadlines the Legislature must meet is June 15, when the 2020-2021 budget must be passed and August 31, signifying the adjournment of the current two-year legislative session (aka “sine die”).

The only way the Legislature will now be able to get through all their business is either by diminishing the workload or extending their session through the currently scheduled Summer Recess in July and/or calling a “Special Session” after the August adjournment. Presumably, a combination of these options will be deployed. Senate President Pro Tem Toni Atkins (D-San Diego) in a letter on April 10, to her members, instructed them to limit their authored bill packages to only a handful by stating,

“I have asked Senators to reconsider their priorities and reduce the number of bills they carry accordingly. For example, I am scaling back my legislative portfolio and plan to pursue only two pieces of legislation this year.”

One Senator I spoke to said he is paring down his bill package from 26 to only six. He also indicated to me that the committee he chairs will only be hearing three bills. Assembly Speaker Anthony Rendon (D-Los Angeles) has indicated that of the approximate 3,000 bills introduced this year, the Legislature will only have the capacity to address 600-700 of those bills. The sole focus of these legislative efforts will obviously be coronavirus-specific but there will also most likely be some attention spent on ongoing wildfire relief efforts and homelessness.

Governor Newsom has already suggested shredding his January 2020 proposed $222 billion budget. According to the California Department of Finance, the state will need approximately $7 billion to fight COVID-19 in California. This coupled with an extension in the state and federal tax filings to July 15, means that the “May Revise” will be renamed the “August Revise.” Tax revenue projections are uncertain but the unprecedented state unemployment numbers coupled with an ongoing downward spiral of the stock market, will precipitate what is being called a “2020-2021 Shelter-in-Place Budget” or in technical speak a “baseline budget” or “workload budget.” This type of budget will simply maintain 2019-2020 existing spending levels.

Projected tax revenue may indeed not outpace current budget obligations which the Legislative Analyst’s Office calls “a budget problem.” Assembly Budget Chair Phil Ting (D-San Francisco) has already warned of potential budget cuts and has unilaterally rescinded almost all legislative budget requests for the creation of new programs and additional revenue for existing programs. In a letter to his colleagues on March 30, Assembly Member Ting stated,

“We must lower expectations about our budget outlook to reflect our new reality. With state revenues likely being dramatically reduced in the coming year, I do not believe we will have resources to fund many Member priorities this year, beyond a small few that deal with the response and recovery to COVID 19.”

The Senate and Assembly are beginning to comb through these budget forecast numbers and analyzing the discretionary spending by the governor on all things COVID-19 related. On April 16, the newly created Senate Special Budget Subcommittee on COVID-19 Response held their first hearing at the Capitol and remotely. After an extended start due to technical online difficulties because an unanticipated additional 10,000 users logged-on remotely, Senate Budget Chair Holly Mitchell (D-Los Angles) and Senator Budget Vice-Chair Jim Nielsen (R-Tehama), in-person and the other committee members remotely, heard presentations from the Legislative Analyst’s Office, California Department of Finance and the California Budget and Policy Center. Committee members had ample opportunity to ask questions and outline their COVID-19 budget priorities going forward. The Assembly Budget Subcommittee on Health and Human Services will be holding their initial hearing on COVID-19 related budgetary items on April 20.

The Senate has also created a dedicated Special Committee on Pandemic Emergency Response, which will be chaired by Senator Lena Gonzalez (D-Long Beach) and vice-chaired by Senator Pat Bates (R-Laguna Niguel). According to the April 15 announcement from the Office of Senate President Pro Tem Toni Akins:

“The Special Committee on Pandemic Emergency Response, a bipartisan committee of eleven senators, is tasked with reviewing the state’s response to the COVID-19 health crisis – what has gone right and what could be improved. The committee also will make findings and recommendations for future preparedness if the coronavirus returns later in the year, or if the state faces a subsequent pandemic.”

While the statewide stay-at-home order remains in effect, stakeholders and the public are being strongly encouraged to participate in any legislative hearings via livestream and accommodations are being made for remote public comment by phone. However, the Capitol will be inexplicably open to individuals wishing to attend these hearings and others in-person. Protocols to protect the public health and physical distancing guidelines will be strictly enforced. In order to maintain physical distancing, seating in the hearing room will be extremely limited. The public has been highly encouraged to use face coverings and admission into the Capitol will commence fifteen minutes before the hearing, and temperature checks will be required as part of the screening process for admission into the Capitol. Capitol elevators are also being limited to one passenger at a time.

So, what does all this mean for you? We will continue to engage directly with the Legislature and the governor’s office to ensure the financial integrity of individual O&P practitioners, practices, suppliers, etc. This will require ongoing coordination with state and federal stakeholders. It will also mean that the COPA advocacy efforts will continue to focus on the state budget process where not only financial and other economic priorities will be realized, but where potential cuts to O&P Medi-Cal provider rates may be heavily debated.

As we move through the COVID-19 surge phase to suppression to herd immunity and finally to a vaccine, it will require a “new normal” lifestyle that is health and common sense-focused. Please stay safe out there and be careful.

 

For any additional questions, please feel free to contact me directly at bdocherty@ka-pow.com.

If you miss a day “Under the Dome” – you miss a lot!