Medi-Cal Reimbursement Limits for DME, Medical Supplies Upheld by Appeals Court

Upper billing limits imposed in 2004 by Medi-Cal program administrators on reimbursement for certain medical supplies and equipment provided to Medicaid recipients were properly implemented and do not violate state law, a California appeals court ruled Sept. 16 (California Ass’n of Medical Products Suppliers v. Maxwell-Jolly, Cal. Ct. App., A126749, 9/16/11).

The California Court of Appeal, First District, said the California Department of Health Care Services complied with the state’s Administrative Procedure Act and did not exceed its authority under Medi-Cal provisions in implementing the upper billing limits (UBLs) for durable medical equipment, dispensed medical supplies, and ...