New CLLS Rate Methodology Posted and Data Submission Deadline Extended

Assembly Bill 1494 authorizes the Department of Health Care Services (DHCS) to develop a new rate methodology for clinical laboratory and laboratory services (CLLS). The new rate methodology determines rates that are comparable to payment amounts received by other payers. To establish this methodology, AB 1494 directs CLLS providers that billed Medi-Cal in 2011 to submit data reports based on the 2011 calendar year. DHCS must determine the average lowest price providers receive from third-party payers other than Medi-Cal and develop rates for these services at either the lowest rate other payers are paying or at 80 percent of the Medicare rate, whichever is lower. DHCS has posted the final rate methodology proposal and electronic spreadsheet that providers must use to electronically submit fee schedules to DHCS on the Clinical Laboratory and Laboratory Services Rate Methodology Change page of the DHCS website. Providers must email their completed fee schedules spreadsheet to labcomments@dhcs.ca.gov. All data submissions must be submitted to DHCS electronically. To ensure providers have adequate time to prepare and submit the data, the deadline for the submission has been extended to May 31, 2013. The data reports submitted to DHCS must be certified by the provider’s certified financial officer or an authorized individual. Providers’ data submissions are confidential.

Source: General Medicine | April 2013 | Bulletin 466