A federal appeals court has denied a request for a review of an earlier decision that cleared the way for Calfornia to implement reimbursement cuts for Medi-Cal, the state's Medicaid program.


Medi-Cal, California Pharmacists Association, CPhA, Medicaid, Jon Roth, en banc review, three-judge panel, 10% Medi-Cal reimbursement cut, California Legislature, AB 97, pharmacists, California Medical Association (CMA) et al. v. Douglas, National Association of Chain Drug Stores, Center for Medicare & Medicaid Services, CMS














































































































































































































































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Court nixes call for review of Medi-Cal ruling

May 28th, 2013

SACRAMENTO, Calif. – A federal appeals court has denied a request for a review of an earlier decision that cleared the way for Calfornia to implement reimbursement cuts for Medi-Cal, the state's Medicaid program.

The California Pharmacists Association (CPhA) said the U.S. 9th Circuit Court of Appeals has turned down a motion by a health care coalition for an en banc review of a ruling last December in which a three-judge panel overturned several injunctions that prevented implementation of the 10% Medi-Cal reimbursement cut passed by the California Legislature in 2011 (AB 97).

In its denial on Friday, the court rejected all of the arguments in the petition for review, CPhA noted.

"While not surprising, we are deeply disappointed in [Friday's] decision and absolutely believe it will result in harm to Medi-Cal patients," CPhA chief executive officer Jon Roth said in a statement. "It is absurd to think you can slash reimbursement rates resulting in pharmacists providing services below their actual costs while at the same time expanding the Medi-Cal program to 4 million additional beneficiaries under health care reform beginning in 2014. I am astonished that the state thinks this will work."

CPhA said the latest ruling narrows the coalition's options in the multiyear effort against a number of provider reimbursement cuts made by California. Besides CPhA, plaintiffs in the lawsuit — California Medical Association (CMA) et al. v. Douglas — include the National Association of Chain Drug Stores, California Hospital Association (CHA), California Dental Association (CDA), California Association of Medical Product Suppliers (CAMPS), AIDS Healthcare Foundation (AIDS) and American Medical Response (AMR).

"At this point, we are weighing all our options, including a petition to the U.S. Supreme Court," Roth stated.

In their earlier decision, the three-judge panel concluded that the court properly deferred to a Center for Medicare & Medicaid Services (CMS) administrative decision that approved the California State Plan Amendment (SPA) allowing the cuts to providers, and that the SPA met the requirements of ensuring access to care under Section 30(A) of the Medicaid statute, according to CPhA.

The panel judges also found that California's secretary of health and human services didn't abuse her authority or discretion in approving the SPA and, as a result, a Supremacy Clause claim isn't applicable.

"The panel's decision ignores its impact on Medi-Cal patients' ability to access quality care," the petitioners said in their request for the en banc review. "Rate cuts only exacerbate the well-known problems Medi-Cal patients face in accessing medical services," they noted.

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