If the State of California does not enact the Fiscal Year 2008-2009 budget by June 30, 2008, the Department of Health Care Services (DHCS) will direct the fiscal intermediary (EDS) to continue to pay Medi-Cal practitioners and institutional providers through the MPIP fund until the loan is exhausted, which is anticipated to be by July 17, 2008. After that date, Medi-Cal institutional providers will not receive payment until a budget is enacted.
Fiscal Year 2008 - 09 August Payment Hold
Assuming the Fiscal Year 2008-2009 state budget will be enacted by no later than July 25, 2008 and effective August 7, 2008, reimbursement to Medi-Cal institutional providers will be held during the month of August and released throughout the month of September.
Provider Payments During Period of No State Budget
If the state of California does not enact the Fiscal Year 2008 -20 09 budget by June 30, 2008, DHCS will direct the fiscal intermediary, EDS, to implement provisions to continue processing and adjudicating claims as outlined below.
EDS will process and adjudicate claims for the following programs, regardless of date of service:
- Medi-Cal
- Family PACT (Planning, Access, Care and Treatment) Program
- California Children's Services (CCS)/Medi-Cal
- Child Health and Disability Prevention (CHDP)/Medi-Cal
- Abortion
EDS will withhold all reimbursements for the following programs regardless of dates of service.
- CCS-only
- Genetically Handicapped Persons Program
- Healthy Families Program
- CHDP-only (claims for clients with aid code 8Y)
Effective for dates of service on or after July 1, 2008, claims submitted by provider types for which contingency funding is not available will continue to be processed, but reimbursement for these claims will be withheld until the state budget is approved and EDS receives approval from the state to resume reimbursement.
June 2008 Provider Payment Deferral
Since Fiscal Year (FY) 2004 - 2005, the last checkwrite in June of the FY has been delayed until the start of the next FY. Beginning with FY 2007 - 2008, an additional checkwrite for all fee-for-service providers will be delayed and paid during the next FY. The deferral of payment of the final two June checkwrites to the following FY will be on a permanent basis. In 2008, these two June checkwrites will be released to providers on July 2, 2008. The following programs are impacted by this delayed payment:
- Medi-Cal
- Abortion
- Healthy Families
- Child Health and Disability Prevention (Aid Code 8Y continues to be paid)
Medicaid Now Reimbursing for Viral Tropism Laboratory
Medicaid now reimburses for viral tropism testing. This test identifies patients who are likely to respond to the new HIV entry inhibitor drug, Selzentry . Currently, one method (Trofile assay) is eligible for coverage; other methods may be covered in the future. Laboratories are required to use MMIS procedure code 87999 to bill for a viral tropism assay test. The laboratory test is a covered service when clinically indicated, up to a maximum of two tests per 12-month period-per-patient.
All ordered tropism assays are reimbursable fee-for-service directly to the testing laboratory. This includes tests ordered for:
- Inpatients of Article 28 residential health care facilities
- Patients of designated AIDS centers operating under the 7 Tier AIDS payment structure
- Patients of Article 28 certified outpatient clinics
- Patients of Article 28 certified free-standing diagnostic and treatment centers
Only Medicaid-enrolled clinical laboratories with Department of Health approval to perform viral tropism assays are entitled to reimbursement.
