Health Equity
News, Statements, and Testimony on Health Equity Issues
25th Council session information coming soon.
DHCF: Notification of Policy Change-Physician Administered Drug Reimbursement Rates
The Centers for Medicare and Medicaid Services (CMS) recently approved an update to the District of Columbia (DC) Medicaid State Plan. The State Plan Amendment allows the Department of Health Care Finance (DHCF) to modify the reimbursement methodology for physician-administered drugs.
Background
DHCF conducted a comprehensive review of the existing reimbursement methodology for physician-administered drugs. Under the previous reimbursement methodology, the "Buy & Bill" providers were reimbursed at 80% of the Medicare Part B reimbursement rate for the ingredient (drug/biologic/biosimilar), except for chemotherapy drugs - which were reimbursed at 100% of Medicare Part B reimbursement rates. Recognizing the financial challenges faced by healthcare providers, DHCF acknowledges that the previous reimbursement rates were insufficient, often falling below the acquisition cost. This discrepancy has, in some cases, rendered the provision of services financially unsustainable, creating a disincentive for providers to offer care to beneficiaries. Consequently, this situation has posed a significant barrier to beneficiaries seeking timely access to essential treatments.
New Policy
DHCF recently received CMS State Plan approval to increase the reimbursement rates for all physician-administered drugs to 100% of Medicare reimbursement rates under the “Buy & Bill” policy. This adjustment aims to better align reimbursement with the actual costs incurred by providers, promoting financial sustainability and, ultimately, improving access to care for DC Medicaid Fee-for Service beneficiaries. This change will have a positive impact on the healthcare landscape, addressing the challenges faced by providers and facilitating more accessible and timely care for beneficiaries. The SPA that reflects this policy change is available at: DC-23-0012.pdf (medicaid.gov).
Policy Effective Date
The effective date of the change is October 1, 2023. All previously submitted claims, impacted by the publication of this transmittal, will be reprocessed by February 29, 2024.
Contact
If you have questions, please contact Amy Xing, Reimbursement Analyst, Office of Rates Reimbursement and Financial Analysis, Department of Health Care Finance (DHCF) at amy.xing2@dc.gov or (202) 481-3375.
Sample of Health Equity Legislation MSDC Tracked
What does it say? The bill allows for the administration of medicinal marijuana in schools as well as allows students to bring sunscreen to schools and apply it without a prescription.
MSDC position: MSDC supports the language permitting sunscreen application in schools
Current status: A win for DC physicians and public health! The legislation passed the Council in February and was signed by the Mayor. Previous temporary and emergency legislation permitted students to use sunscreen at schools this school year already.
What does it say? The bill requires DC Health to establish an electronic Medical Order for Scope of Treatment registry (eMOST).
MSDC position: MSDC supports this legislation to more easily allow patients to make their treatment orders known.
Current status: A win for the physician community and our patients! The Council passed the bill in December and the Mayor signed it into law on January 16, 2020.
What does it say? The bill would implement a 1.5 cent per ounce tax on the distribution of "sugary" beverages. The money collected from the tax would establish a Healthy People, Healthy Places Open Spaces Grant Program.
MSDC position: MSDC sent a letter to Council Chair Mendelson asking for a hearing to discuss all of the issues around a beverage tax.
Current status: The bill was introduced October 8, 2019 and referred to the Committee on Business and Economic Development and the Committee of the Whole.