-
DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes approved December 27, 1967 (81 Stat.774; D.C. Official Code §1-307.02) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code §7-771.05(6)), hereby gives notice of the adoption, on an emergency basis, of an amendment to section 995, “Medicaid Physician and Specialty Services Rate Methodology,” of Chapter 9, “Medicaid Program,” of Title 29, “Public Welfare” of the District of Columbia Municipal Regulations (DCMR).
Medicaid reimbursement rates for fee-for-service physician and specialty services are consistent with the rates paid by the Medicare program. Beginning FY 2011, physician and specialty services shall be reimbursed at eighty percent (80%) of the Medicare rate.
DHCF projects an annual decrease in aggregate expenditures of $8.1 million as a result of the reduced reimbursement rate in FY 2011.
In Fiscal Years 2009 and 2010, the District experienced an unprecedented growth in unemployment from 5.7% to 11%. During this period, the Medicaid program has experienced huge pressures in enrollment. Emergency action is required to preserve the health, welfare and safety of District residents during this crisis, since DHCF must reduce spending to pay for the health care needs of District residents.
DHCF is also amending the District of Columbia State Plan for Medical Assistance (State Plan) to reflect these changes. The State Plan amendment will be submitted to the Council of the District of Columbia (Council) and the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) for approval. These rules shall become effective for services rendered on or after October 9, 2010, if the corresponding State Plan amendment has been approved by CMS with an effective date of October 9, 2010, or the effective date established by CMS in its approval of the corresponding State Plan amendment, whichever is later. These rules are also contingent upon approval by the Council of the corresponding State Plan amendment. If approved, DHCF will publish a notice which sets forth the effective date of the rules.
The emergency rulemaking was adopted on September 24, 2010, and shall become effective for services rendered on or after October 9, 2010, subject to CMS approval. The emergency rules shall remain in effect for one hundred and twenty (120) days or until January 21, 2011, unless superseded by publication of a Notice of Final Rulemaking in the D.C. Register. The Director also gives notice of the intent to adopt this proposed rule not less than thirty (30) days from the date of publication of this notice in the D.C. Register.
Section 995, MEDICAID PHYSICIAN AND SPECIALTY SERVICES RATE METHODOLOGY, of Chapter 9, MEDICAID PROGRAM, of Title 29, PUBLIC WELFARE, of the DCMR is amended by amending Subsections 995.1 and 995.2 to read as follows:
995.1 For services rendered on or after October 9, 2010, Medicaid reimbursement rates for fee-for-service physician and specialist services shall be eighty percent (80%) of the rates paid by the Medicare Program as set forth in this section.
995.2 For services where the physician and specialist service procedure code falls within the Medicare (Title XVIII) fee schedule, payment shall be the lesser of the Medicare rate established pursuant to section 995.1 or the providers’ actual charges to the general public.
Comments on the proposed rules shall be submitted, in writing, to Julie Hudman, PhD., Director, Department of Health Care Finance, 825 North Capitol Street, N.E., 6th Floor, Washington, D.C. 20002, within thirty (30) days from the date of publication of this notice in the D.C. Register. Copies of the proposed rule may be obtained from the same address.
