2008-09 State Budget
References
2008-09 State Budget: Provider Payment Reduction FAQs
- Why are my payments for services going to be reduced?
A: The reduction in provider payments is necessary to reduce California's significant budget deficit.
- Why aren’t all provider payments being reduced?
A: The providers affected are specifically identified in the State legislation.
- How much will the provider payment reduction be and who does it affect?
A: The reduction is 10 percent of the final reimbursement amounts and it affects payments for Medi-Cal fee-for-service benefits and non Medi-Cal programs with rates that are identical to Medi-Cal rates. The following non Medi-Cal programs shall be reduced:
- California Children's Services (CSS)
- Genetically Handicapped Persons Program (GHPP)
- State-Only Family Planning Program (except aid code 8H)
- How would I know if my claims payments were reduced?
A: Please refer to your Medi-Cal Update bulletins. If the provider type, services or program is not exempt, then payments will be reduced by 10 percent.
- What services are exempt from this provider payment reduction?
A: The following services are exempt from the 10 percent provider payment reduction. Please refer to your Medi-Cal Update bulletins for the exempt services.
- Acute hospital inpatient services provided under contract with the Department of Health Care Services (DHCS).
- Federally Qualified Health Center services (FQHC).
- Rural Health Clinic services (RHC).
- Skilled Nursing Facilities (SNF) except an SNF that is a distinct part of a general acute care hospital.
- Intermediate Care Facilities for the Developmentally Disabled (ICF-DD) providing continuous skilled nursing care to developmentally disabled individuals.
- Free-standing Subacute Care Units.
- Payments to facilities owned or operated by the Department of Mental Health or Department of Developmental Services.
- Hospice Care Program (HOS) services.
- Contract services as designated by the director.
- Payments to providers to the extent that the payments are funded by means of a certified public expenditure or an intergovernmental transfer.
- Services pursuant to local assistance contracts and interagency agreements to the extent the funding is not included in the funds appropriated to the department in the annual Budget Act.
- Payments to Medi-Cal managed care plans for services to consumers transitioning from Agnews Developmental Center in Alameda, San Mateo and Santa Clara counties pursuant to the Plan for Closure of Agnews Developmental Center.
- Breast and Cervical Cancer Treatment Program (BCCTP).
- Family PACT (Planning, Access, Care and Treatment).
- Expanded Access to Primary (EAP) Care Clinics.
- Local Education Agency (LEA).
- Developmentally Disabled Home and Community-Based Services.
- Institutions for Mental Disease.
- Multi-purpose Senior Services Program (MSSP).
- Indian Health Services (IHS).
- Children's Treatment Program (CTP).
- Long Term Care (LTC) Crossover Claims.
- Out-of-state Inpatient Providers.
- Personal Care Services/In-Home Support Services.
- What criteria were used to apply the reduction?
A: The reductions described will apply only to payments for services when the general fund share of the payment is paid with funds directly appropriated to DHCS in the annual Budget Act and will not apply to payments for services paid with funds appropriated to other departments or agencies.
- How would managed care plans be impacted by the payment reduction?
A: Payments to managed care plans will be reduced by the actuarial equivalent amount of the payment reduction. Each managed care plan will decide how to address this reduction and how it affects the providers under that managed care plan.
- Will the payments revert back to the regular amount at a later date?
A: No. Unfortunately, the payment reduction will remain in place until new legislation is passed to amend or repeal the existing statutes.