Judge: State Failed To Properly Evaluate Rates for Medi-Cal Payments

Los Angeles Superior Court Judge Ann Jones recently ruled that the California Department of Health Care Services did not adequately review Medi-Cal reimbursement rates to determine whether they were high enough for physicians to participate in the program, American Medical News reports. Medi-Cal is California's Medicaid program.

Background

In January 2009, members of the California Chapter of the American Academy of Emergency Physicians filed a complaint seeking to force the state to conduct annual reviews of Medi-Cal reimbursement rates as required under California law.

State law requires regulators to review Medi-Cal rates and adjust them annually based on:

• Physician reimbursement levels for Medicare and additional third-party payers;
• Average physician charges within the state and other geographic areas;
• Medical services needed by Medi-Cal beneficiaries; and
• The consumer price index.

Ruling, Response

Jones' ruling states that DHCS compared Medi-Cal payments with Medicare rates for certain codes. However, it notes that DHCS might not have conducted sufficient rate reviews to meet all of the state requirements.

DHCS spokesperson Anthony Cava declined to comment on the lawsuit but said the department is considering appealing the ruling (Trapp, American Medical News, 11/15).