We're 'crossing our fingers'
SACRAMENTO, Calif. - With their settlement with California's Department of Health Services now on the books, the state's HME association and providers await to enjoy the fruits of their hard-earned labor.
"We just submitted 10 (treatment authorization requests or TARs) in the past few weeks," said Mark Ehlers, owner of Ehler's Health Supply in Stockton, Calif. "We're crossing our fingers that things work the way they're supposed to."
Beginning in January, the state improved reimbursement for oxygen and rehab equipment. The changes resulted from years of costly negotiations between the state and the California Association of Medical Products Suppliers (CAMPS). The association went so far as to sue the state in July 2004, but the two parties never made it to court (See HME News March 2006).
The biggest changes: The state's Medicaid program, Medi-Cal, now pays about $61 per month for gaseous oxygen instead of $4 per tank. For rehab equipment, it pays 15% below MSRP instead of a tiered discount. Medi-Cal also increased the labor rate for rehab repairs by about $30 per hour.
Even with these changes, there's still work to be done, said Bob Achermann, executive director of CAMPS. For example, as part of the settlement, the state had agreed to pay about $140 per month for gaseous oxygen (80% of Medicare's $175). When CMS cut reimbursement this year, however, Medi-Cal was forced to adjust the rate to $61 per month.
"That's beyond our control," Achermann said. "But we're trying to move back toward the original concept, arguing that Medi-Cal recipients, because they're younger and more ambulatory, use more oxygen."
Most recently, CAMPS proposed that Medi-Cal allow providers to bill $61 twice per month for two deliveries (On average, Medi-Cal recipients use six to eight tanks per month, Achermann said). The association's awaiting a response.
"(The settlement) is a win, but it's not the complete solution," Ehlers said.