governor Signs State Budget

Governor Gavin Newsom signed the California State Budget, marking the end of the negotiation process between the executive branch and state legislative branch. Working through the budget process, and on the heels of the Governor’s declaration that he wanted to deliver an early budget, Newsom and legislative leaders agreed to a final $214.8 billion budget late in the afternoon on Sunday, June 9th. The Legislature also passed several trailer bills, so-named because they “trail” the budget and are needed to implement various aspects of the budget plan.

 

Investments in health and human services are a major component of the budget, including an expansion of Medi-Cal coverage to young undocumented adults and expanded eligibility for health insurance subsidies for the middle class.

 

Healthcare has been a significant priority of both the Newsom Administration and Democrats in the Legislature, and this budget achieves many of their goals. Major components of the 2019-20 HHS Budget include:

 

  • The Budget implements an individual healthcare mandate and penalty, similar to the mandate under the Affordable Care Act that was repealed in recent years by the federal government. It also includes provisions to allow Covered California to offer health insurance subsidies to people between 200% and 600% of the federal poverty level.
  • Undocumented immigrant adults between ages 19-26 will be eligible for healthcare benefits under the Medi-Cal program.
  • The Managed Care Organization (MCO) Tax, which will expire next month, has not been extended yet, but the Legislature did adopt placeholder trailer bill language to authorize the MCO tax.
  • The Governor’s proposed budget included numerous supplemental Medi-Cal provider payments to be funded by tobacco tax revenue authorized by Prop 56. Among other things, they include rate increases for physicians, dentists, pediatric subacute facilities, the mental health workforce, ICF-DDs, funds for Medi-Cal women’s health, trauma and developmental screenings, and Value-Based Payments.

OPSC remins committed to working with the legislature and governor to ensure health care remains a priority in future budgets. 

Osteopathic Manipulative Treatment Now Covered by Medi-Cal

The California Department of Health Care Services (DHCS) recently announced that Medi-Cal now covers Osteopathic Manipulative Treatment (OMT). The Medi-Cal Provider Manual states that OMT is reimbursable only when rendered by physicians skilled, trained and experienced in providing OMT services.

 

OMT coverage in Medi-Cal is the result of the tireless efforts of the staff and physician leadership at the Osteopathic Physicians and Surgeons of California (OPSC). While OMT coverage is an essential first step for osteopathic physicians in California, we continue to work with the Department to clarify regulations and expand coverage to the full potential of OMT. 

 

Currently, OMT coverage in Medi-Cal is limited to CPT codes 98925 and 98926 when billed in conjunction with ICD-10 diagnosis code M99.01, M99.02, M99.03, M99.04, or M99.05. The frequency of treatment is also limited to 12 procedures per year.

 

OPSC is committed to working with DHCS to expand OMT coverage beyond this initially limited definition. In the meantime, we urge physicians practicing OMT to consult the Medi-Cal Provider Manual for specific information on requesting reimbursement from the system.

 

If you have any questions or require additional information, please contact the OPSC office at 916-822-5246.    

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