Here’s a quick recap of events: 2011’s AB 97 reduced Medi-Cal reimbursement rates for Distinct Part Skilled Nursing Facilities (DP/SNFs) to rates applicable in the 2008-2009 rate year, less 10%, resulting in effective rate decreases for most facilities of about 25%. In 2013, the Legislature recognized the devastating impact these cuts would have and acted to restore the rates on a prospective basis. However, these essential providers still face the prospect of retroactive recoupment of millions for services provided from June 1, 2011 to September 2013. DP/SNFs in rural areas of the state were spared losses from these cuts earlier this year, leaving urban centers clinging to their seats as AB 900 (Alejo, D-Salinas) parked in the Senate Appropriations Committee and AB 1805 (Skinner, D-Berkeley / Pan, D-Sacramento) landed in the Assembly Appropriations Committee…

Onto the budget: While the 2014-2015 budget proposes to relieve retroactive rate reductions to doctors, clinics and some other providers, it does not eliminate the retroactive cuts for hospital based DP/ SNFs leaving these facilities vulnerable to the looming “clawback.” In late June, both the Senate and Assembly passed the State Budget onto the Governor after much discussion in conference committee – noted the Assembly version included retroactive forgiveness of the cuts.

While it might seem over, let me assure you that there is still a fight to be had. The Legislature is near the end of its month long recess; Aug. 4th begins the final effort to finish all legislative activity before the close on Aug 31. What to do?

With a projected budget surplus, Sacramento has a rare opportunity to undo some of the most damaging cuts. Let’s make Medi-Cal a top priority. The Legislature and Governor Brown have committed to ensuring more patients have access to care by expanding Medi-Cal eligibility. With millions of new patients entering the health care delivery system it is more important than ever that we have enough doctors, hospitals and health care workers to provide patients the care they’ve been promised. Seniors with complex health needs must take priority and have access to hospital-based skilled nursing facilities without fear of these facilities shutting down simply because they cannot afford to stay open. California is already paying health care providers lower rates than any other state’s Medicaid program, and as a consequence, access is limited. By driving providers out of Medi-Cal and shifting costs onto the private sector the State will succeed in making routine care even less available.

As the Legislature and Governor negotiate last-minute details before closing down for the year, let’s remind them that they can still protect DP/SNFs from these devastating clawbacks. The retroactive collection of monies dating back to 2011 will place a significant financial burden on hospitals caring for our most vulnerable patients.

The Ask: Please call, email or write your state Assemblymember and state Senator and urge them to extend the elimination of the clawback to all providers. Let’s protect seniors from undue hardship and preserve these medically necessary services.