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Update: Ten Percent Payment Reduction for DME Providers

September 22, 2016

This article updates information published in the September 2016 Medi-Cal Update. The previous article is updated below.

Effective retroactively for dates of service from June 1, 2011, through October 23, 2013, a 10 percent payment reduction for Durable Medical Equipment (DME) services and supplies is implemented in accordance with Assembly Bill 97.

Due to court injunctions, AB 97 did not initially result in payment reductions for DME providers. The injunctions were lifted on June 14, 2013, and the Department of Health Care Services (DHCS) was given authority to retroactively collect the 10 percent payment reduction. Providers will receive notification 60 days prior to the processing of an Erroneous Payment Correction (EPC).