S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7892--A
                                                            R. R. 410
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 28, 2021
                                ___________
 
 Introduced  by  M.  of A. GUNTHER, SIMON, SAYEGH, ASHBY -- read once and
   referred to the Committee on Health -- recommitted to the Committee on
   Health in accordance with Assembly Rule 3,  sec.  2  --  reported  and
   referred  to  the Committee on Ways and Means -- reported and referred
   to the Committee on Rules -- amended on the  special  order  of  third
   reading,  ordered  reprinted  as  amended,  retaining its place on the
   special order of third reading
 
 AN ACT directing the commissioner of health to conduct a  study  on  the
   rates  of reimbursement made through the New York state Medicaid dura-
   ble medical equipment, orthotics, prosthetics and supplies program for
   rate adequacy and patient access; and providing for the repeal of such
   provisions upon expiration thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. The commissioner of health shall conduct a study to review
 the rates of reimbursement made through  the  New  York  state  Medicaid
 durable  medical  equipment, orthotics, prosthetics and supplies program
 for rate adequacy and patient access, including  those  made  under  all
 capitated and contract coverage models. Such review shall include:
   (a)  an  analysis of rules, regulations and policies for orthotics and
 prosthetics  service/device  provisions  under  the  New  York  Medicaid
 program, including all contracted and capitated models;
   (b)  a  comprehensive  assessment  of the existing methodology used to
 determine payment or nonpayment for prosthetic and orthotic care includ-
 ing but not limited to:
   (i) all orthotic and prosthetic codes  on  the  current  Medicaid  fee
 schedule,  including but not limited to a comparison of prevailing Medi-
 care fee schedule amounts and New York Medicaid amounts;
   (ii) codes on the Medicare fee schedule but not included  on  the  New
 York  state  Medicaid  durable medical equipment, orthotics, prosthetics
 and supplies program fee schedule;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11559-02-2
 A. 7892--A                          2
 
   (iii)  recommendations  for  changing   reimbursement   methodologies.
 Recommendations under this subparagraph shall be consistent with federal
 law  and  shall include recommendations for appropriate changes in state
 law and regulations. Such  recommendations  shall  consider  appropriate
 payment  methodologies for codes not included on the Medicaid fee sched-
 ule;
   (c) assessment of barriers to timely  service  provision  as  well  as
 racial and socioeconomic disparities in access including, but not limit-
 ed  to, travel time required, geographic variability, access to and cost
 of technology;
   (d) the workforce needed to provide orthotic and  prosthetic  services
 in the next five years to eligible children and adults, disaggregated by
 county;
   (e) opportunities for stakeholder input on current rate methodologies;
 and
   (f)  assessment of cost savings associated with percentage of Medicaid
 population returning to work after orthotic and/or prosthetic provision.
   § 2. Within one year after the effective date of this act, the commis-
 sioner of health shall submit a report of the findings  and  recommenda-
 tions  pursuant  to this act to the governor, the temporary president of
 the senate, the minority leader of the senate, the speaker of the assem-
 bly, the minority leader of the assembly, and  the  chairs  and  ranking
 members  of  the senate and assembly committees on health and shall post
 such report on the department of health's website.
   § 3. The commissioner of health  shall  be  authorized  to  promulgate
 rules  and  regulations  to  provide for the orderly effectuation of the
 provisions of this act.
   § 4. This act shall take effect immediately and shall  expire  and  be
 deemed  repealed  upon the submission of the report required pursuant to
 section two of this act.