California

The Department of Health Care Services (DHCS) submitted a disaster relief SPA to the Centers for Medicare & Medicaid Services requesting an increase in reimbursement rates for DME oxygen and respiratory equipment, retroactively effective for dates of service beginning on or after March 1, 2020, or at a later date when DHCS implements the new procedure code. DHCS seeks reimbursement rates for 100 percent of the corresponding Medicare rate. The federal fiscal impact for the rate increase is estimated at $3.4 million.

Also in California. The Department of Health Care Services (DHCS) will not resume retroactive pharmacy claim adjustments on February 11. The retroactive pharmacy claim adjustments due to a change in the reimbursement methodology for covered outpatient drugs in 2017 will continue to be paused until further notice. This pause will apply to all pharmacy claims billed through the Medi-Cal fee-for-service Fiscal Intermediary and includes those claims that were also subject to an alternative payment arrangement.

Also in California. The Board of Pharmacy issued a proposed rule establishing training requirements for pharmacists to independently initiate and provide to patients HIV preexposure and postexposure prophylaxis. The rule also would establish related recordkeeping requirements.

Lastly in California. NACDS co-signed a Coalition letter supporting Gov. Gavin Newsom’s (D) budget proposal authorizing Medi-Cal coverage for Continuous Glucose Monitoring Systems.

For more information, contact NACDS’ Mary Staples at 817-442-1155.