Effective for dates of service on or after March 1, 2009, Medi-Cal payments to providers (unless exempted) will be subject to a 1% or 5% reduction, based on provider type. Welfare and Institutions Code (W&I) Section 14105.191 mandates the application of the 1% and 5% reduction with certain exceptions as noted therein. On February 27, 2009, the U.S. District Court issued a preliminary injunction instructing the Department of Health Care Services not to implement the 5 % payment reduction mandated by W&I Section 14105.191, as modified by AB 1183 (2008), to pharmacies for prescriptions drugs (including prescription drugs and traditional over-the-counter drugs provided by prescription) provided under the Medi-Cal fee-for-service program. For additional information on the payment reduction and the impact of the injunction, please refer to the Newsroom articles posted on the Medi-Cal home page.
The reimbursement rates published on this Website do not reflect the following payment augmentations or reductions that are applied as part of the final payment to Medi-Cal providers:
- 1% or 5% payment reductions as specified above
- 43.44% payment augmentation for services provided in a hospital outpatient department
- 39.7% payment augmentation for specified physicians’ services provided to California Children’s Services clients