Court denies second hearing on Medi-Cal rate cut
National News
A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state's 10 percent provider rate cut for treating the poor.
The 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had ruled against them in December on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.
Health providers vowed they will continue to press lawmakers to restore the 10 percent reimbursement rate cut to the state's Medicaid program, known as Medi-Cal.
"While we are not surprised by the 9th Circuit Court ruling, we are certainly disappointed, as the 10 percent cut to Medi-Cal will have devastating effects on California's poorest and most vulnerable patients," said Paul Phinney, president of the California Medical Association, in a statement.
Phinney said the state needs competitive Medi-Cal payments as the state prepares to get millions of Californians health coverage under the Affordable Care Act. The association, which represents 35,000 doctors, says ongoing cuts have left doctors with little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them.
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.