Medicare / Medical Update

MEDICARE & MEDI-CAL UPDATE
July 1, 2008

For the 1 7th time in the last 20 years, the Legislature and Governor have failed to agree on a state budget by the first day of the fiscal year. Not to be outdone, last week the U.S.Senate failed by two votes to act on an overwhelmingly approved House bill to block the 10.196 reduction in Medicare Part B provider payments, also taking effect today.

The news isn't all bad. Here's a brief update on three fronts, one Medicare and two Medi-Cal:

• Department of Health and Human Services Secretary Mike Leavitt has frozen existing Medicare reimbursement rates until at least July 10 to hold fee-for-service providers harmless until the Congress returns from its July 4 recess to take another shot at agreement - so, the ax hasn't yet fallen. He's also stated that the Center for Medicare and Medicaid Services would consider retroactive payment for services if the dispute is not resolved by then.

• The Assembly and Senate proposals for the 2008-09 state fiscal year, beginning today, are in conference committee to reconcile differences. The committee is essentially marking time as negotiations among the majority and minority legislative leaders continue. Neither house approved the Governor's request to eliminate "optional" adult optometric and optical services; the Assembly rejected the 10% provider payment reduction, and the Senate reduced it to 5%.

COA is a plaintiff along with 50+ other provider organizations, led by the California Medical Association, to block implementation of the 10% provider payment reduction passed in emergency session in January that takes effect today. After some procedural skirmishing in Los Angeles Superior Court - the Attorney General, representing the Department of Health Care Services, tried to remove the case to federal court, but lost - our counsel expects to file a motion for a temporary restraining order (TRO) that will be heard in the next couple weeks and current-year payments start to come due. (In a similar action filed by independent pharmacies in Sacramento the judge has scheduled a hearing on their motion for a TRO this Thursday. We feel our chances are good on both the facts and the law. (Personal thanks to the Board of the Public Vision League for their generous support and to Drs. Tony Carnevali, Hilary Hawthorne, and Jay Messinger for volunteering to be declarants in the case.)

You'll be hearing from AOA about when to contact your federal legislators to protect Medicare reimbursements and from me when it's time to tell your state representatives and the Governor to do the right thing and protect optometry in Medi-Cal. I urge you to respond to both calls when they're made.
For more information, contact Tim Hart or Sean South at 916-441-3990 or at timh .coavision.org or ssouth@coavision.org