California Medical Groups File Lawsuit Challenging Medi-Cal Payment Cuts November 22, 2011 Advocacy, CMA, News CMA, HHS lawsuit, Medi-Cal Cuts 0 [caption id="" align="alignright" width="191" caption="Credit: Robin Wulffson, MD"][/caption] On Monday, the California Medical Association, along with the California Dental Association, the California Pharmacists Association and the National Association of Chain Drug Stores, filed a lawsuit against HHS and the state Department of Health Care Services over the recent approval of a 10% cut in Medi-Cal reimbursement rates. Background In October, CMS approved the state's plan to reduce certain Medi-Cal payments by 10%. According to DHCS, CMS has allowed the state to make a 10% reimbursement cut to: A number of providers and outpatient services, including clinics, dentists, laboratories, optometrists and pharmacists; and Freestanding nursing and adult subacute care facilities, as well as other nursing facilities. The cuts are retroactive to June 1. Heath care providers and patient advocates have argued that the cuts would cause more health care providers to stop treating Medi-Cal beneficiaries. An independent study recently commissioned by CMA found that 49 percent of Medi-Cal patients are unable to get health care when they need it, compared to just 26 percent of privately insured patients. Lawsuit Details According to the lawsuit, the 10% cut to reimbursement rates did not go through the appropriate legal procedures. “In late September, CMS asked DHCS for more information that would substantiate their state plan amendments (SPAs) for cuts in the Medi-Cal program. Without receiving that information, CMS went ahead and approved the cuts,” said Francisco J. Silva, CMA General Counsel and Vice President. “It is clear that CMS did not follow protocol and applied the wrong legal standard. The approval of the SPAs will have dramatic effects on access to health care for the poorest, most vulnerable Californians.” CMA also argue that the cuts will further harm the Medi-Cal system and that beneficiaries already find it challenging to find physicians who participate in Medi-Cal. What You Can Do CMA and its member physicians want to make sure that Medi-Cal patients have access to health care, and we need your help! Contact CMA if you, your clinic, or medical group can no longer afford to treat Medi-Cal patients, cannot find specialists who take Medi-Cal patients, or would otherwise be negatively impacted by the recent cuts that California made to the Medi-Cal program. You can also download a form to give to your patients to determine how they’re being affected. You can help us in our efforts to reverse these cuts. Source: AP/Sacramento Bee, November 21, 2011. Comments are closed.
