Seven California Counties Push Challenge to Medicare Pay Rates
On Monday, a three-judge panel of the Ninth U.S. Circuit Court of Appeals heard arguments from seven California counties aimed at increasing Medicare reimbursement rates for physicians practicing in the counties, the Santa Cruz Sentinel reports.
The counties involved are:
- San Diego;
- San Luis Obispo;
- Santa Barbara;
- Santa Cruz; and
- Sonoma (Brown, Santa Cruz Sentinel, 4/14).
Under Medicare reimbursement rules, Santa Cruz and 40 other California counties are categorized as "rural," resulting in payments that are about 16% lower than reimbursements for providers in neighboring Santa Clara County (California Healthline, 2/23).
According to the Sentinel, lower reimbursement rates deter physicians from opening new practices in the counties and prompt many local physicians to accept fewer Medicare beneficiaries as patients.
The appeals court panel agreed to hear the case on an expedited basis after the counties asserted that the low reimbursement rates had created a public health crisis by causing a physician shortage.
The U.S. District Court in San Francisco declined to hear the case in May 2008, ruling that the counties had not proved they had a constitutional claim to higher pay under equal property protections and that Medicare law permits judicial review of rates.
A ruling is expected within a few months, the Sentinel reports.
Legislative Fix?On Thursday, aides to House Speaker Nancy Pelosi (D-Calif.) and Rep. Sam Farr (D-Calif.) are scheduled to meet with Medicare officials to discuss the dispute over reimbursement rates (Santa Cruz Sentinel, 4/14). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.