SACRAMENTO, CA – We the DMEs in California were powerless. The California Department of Health Services (DHCS) sent out a notice on Dec. 23, 2018 effective Jan. 1, 2019, that our Medi-Cal was going to go to 80% of Medicare’s non-rural rates for most DME items, with an additional 10% reduction based on budget cuts in 2011.
An oxygen concentrator rental would have decreased about 70% to $42 a month from $137. The changes were submitted to CMS in late December 2018 to take effect in January 2019. Many of our DMEs banded together and said enough was enough. Too often, we felt powerless to impact change. Not this time. We organized an effort to impact change.
We organized local meetings with other DMEs and started a grass roots effort. We wrote letters to the CMS regional office to request that they not approve the Medi-Cal changes, arguing the impact on access of care. We tried to work with DHCS instead of at DHCS by pointing out our concerns. They in turn decided to re-look at the issue. In the end, we were successful.
CMS refused to approve the state changes as originally proposed. We submitted a letter on behalf of more than 170 DMEs, stating that if these decreased rates took effect that DMEs would no longer accept Medi-Cal referrals. We told them their claimed pool of providers was dramatically overstated and that all DMEs are not the same. Many had closed, weren’t accepting Medi-Cal referrals, or did provide all product categories.
DHCS agreed to change the Medicare reimbursement rate from non-rural to rural. We are urging them to change to 100% of Medicare rural for all DME and to eliminate the 10% reduction. We will ask legislators to author a bill to make those changes and encourage same in the budget process this Spring.
DMEs have been treated as if we are a commodity supplier and we are all interchangeable with every other DME. We have been competing against internet or distributors’ prices. We provide essential services to patients, skilled respiratory therapists for 02 and vent care, or an ATP to fit and troubleshoot a complex rehab chair. We have allowed ourselves to be priced in a HCPCS code inclusive of all services/ support required for patient care, accreditation, and licensure.
Most importantly, we California DMEs banded together and got out of our silos. We now know and trust a lot of our colleagues in DME, and that quite frankly is a refreshing change. We celebrated what was right in our peer DMEs and stopped trying to protect only our niche.
We feel empowered and optimistic about our futures as DMEs. With the post-acute care market becoming so much a focal point for the health care industry, DMEs are positioned to get a “seat at the table” to help that change. Without home medical equipment, there is no home care.
After all, that’s been our goal all along; to provide support to allow our patients to have the dignity and comfort of recuperating or remaining in their own home for their healthcare. Together, we are stronger than each of us alone. We look forward to 2020 being a great year for DMEs.
Terry Racciato, RN, PHN, is president of the California Association of Medical Product Suppliers, Sacramento, California.