Key Accomplishments​

• Sponsored several pieces of legislation which streamlined and clarified the confusing hemodialysis technician training and testing law, originally passed in 1981. 

• Sponsored legislation to eliminate the need for a Treatment Authorization Request (TAR) prior to initiating dialysis for Medi-Cal patients.

• Worked with the Rate Development Branch in the Department of Health Care Services to secure a 2.4% rate increase in Medi-Cal rates in 2001.

• Stopped legislation to limit the number of lab tests for Medi-Cal patients to 6 per month.

• Sponsored legislation and worked with the Department to set reasonable clinic licensure fees.

• Strenuously opposed and ultimately defeated several attempts to eliminate non-emergency medical transportation (NEMT) provided to ESRD patients under the Medi-Cal program.

• Worked to improve ESRD claims processing procedures under Medicare and Medi-Cal.

• Established an administrative office to serve as a resource for the CDC membership.

• Worked to add important medications to the Medi-Cal formulary and to establish Medi-Cal reimbursement for EPO and Urokinase to be in line with that of Medicare.

• Established an ESRD Network Liaison committee to work with Networks 17 & 18.

• Sponsored legislation which eliminated duplicative reporting requirements of the Office of Statewide Health Planning & Development (OSHPD) as required in the State Annual Report of Clinics.

• Developed a "Managed Care Document" as an aid to facility members in the education of Managed Care Organizations regarding dialysis.

• Worked closely with ESRD Network 17 and DHS after the 1991 Northridge earthquake to educate members on disaster preparedness.

• Established liaisons with national ESRD organizations.

• Opposed various attempts to reduce reimbursement rates for services provided to Medi-Cal beneficiaries. 

​

​

Quantifying Savings

To quantify just a few of our accomplishments (based on an 85 patient hemodialysis unit):
 

• Licensing fees: the decrease in licensing fees averaged over an 85 patient unit that performs 13,260 treatments per year is $0.08/treatment.

• Without Medi-Cal transportation, patients would miss treatments, resulting in lost revenue to the facility and an increase in hospitalizations. The statewide average of Medi-Cal patients is 27%. If seventeen patients have Medi-Cal and miss 10% of their treatments for a year due to ride problems, the facility loses revenue of almost $50,000 per year, or $3.75 per treatment averaged over the total treatments for the facility for the year.

• Elimination of the Medi-Cal crossover, taking into account the 20% of the composite rate, and 20% of the average amount of reimbursable medications, would amount to $44.02 lost revenue per treatment.

• Eliminating reuse of dialyzers, taking into account reprocessing equipment, supplies, and labor would still result in a loss of $13.03 per treatment.

• The legislature proposed to eliminate 12/13 of the monthly capitation fee paid to nephrologists for Peritoneal Dialysis patients. The rationale was that they were seen in clinic only once a month. Decreasing this reimbursement would have result in a loss of $6.65 per treatment averaged more than 30 PD treatments per month.

• These savings add up to over $60.88 per treatment, not including the nephrologist PD fee!