NY State Senate Bill 2021-S7023A

Senate Bill S7023A

2021-2022 Legislative Session

Directs the commissioner of health to conduct a study on rate adequacy of orthotics and prosthetics

download bill text pdf

Archive: Last Bill Status - In Assembly Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 31, 2022	referred to ways and means returned to assembly repassed senate
May 24, 2022	amended on third reading 7023a
May 24, 2022	vote reconsidered - restored to third reading returned to senate recalled from assembly
Feb 16, 2022	referred to ways and means delivered to assembly passed senate
Jan 18, 2022	advanced to third reading
Jan 12, 2022	2nd report cal.
Jan 11, 2022	1st report cal.118
Jan 05, 2022	referred to health
May 24, 2021	referred to health

Votes

- May 31, 2022 - Floor Vote
  S7023A
  
  63
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: May 31, 2022
      
      aye (63)
      
      Addabbo Jr.
      
      Akshar
      
      Bailey
      
      Biaggi
      
      Borrello
      
      Boyle
      
      Breslin
      
      Brisport
      
      Brooks
      
      Brouk
      
      Cleare
      
      Comrie
      
      Cooney
      
      Felder
      
      Gallivan
      
      Gaughran
      
      Gianaris
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Jordan
      
      Kaminsky
      
      Kaplan
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martucci
      
      Mattera
      
      May
      
      Mayer
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rath III
      
      Reichlin-Melnick
      
      Ritchie
      
      Rivera
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Savino
      
      Sepúlveda
      
      Serino
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Weik
  Feb 16, 2022 - Floor Vote
  S7023A
  
  63
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Feb 16, 2022
      
      aye (63)
      
      Addabbo Jr.
      
      Akshar
      
      Bailey
      
      Biaggi
      
      Borrello
      
      Boyle
      
      Breslin
      
      Brisport
      
      Brooks
      
      Brouk
      
      Cleare
      
      Comrie
      
      Cooney
      
      Felder
      
      Gallivan
      
      Gaughran
      
      Gianaris
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Jordan
      
      Kaminsky
      
      Kaplan
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martucci
      
      Mattera
      
      May
      
      Mayer
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rath III
      
      Reichlin-Melnick
      
      Ritchie
      
      Rivera
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Savino
      
      Sepúlveda
      
      Serino
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Weik
  Jan 11, 2022 - Health Committee Vote
  S7023A
  
  14
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Jan 11, 2022
      
      aye (14)
      
      Biaggi
      
      Boyle
      
      Brouk
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      May
      
      Oberacker
      
      Rath III
      
      Rivera
      
      Ryan
      
      Salazar
      
      Stec
      
      Thomas

Bill Amendments

Original

A (Active)

co-Sponsors

2021-S7023 - Details

See Assembly Version of this Bill:: A7892
Current Committee:: Assembly Ways And Means
Law Section:: Public Health
Versions Introduced in 2023-2024 Legislative Session:: S3131, A5113

2021-S7023 - Summary

Directs the commissioner of health to conduct a study on 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.

2021-S7023 - Sponsor Memo

                                
 
BILL NUMBER: S7023

SPONSOR: MANNION
 
TITLE OF BILL:

An act directing the commissioner of health to conduct a study on 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; and providing for the repeal of such
provisions upon expiration thereof

 
PURPOSE:

To conduct a study to review the rates of reimbursement made through the
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.

 
SUMMARY OF PROVISIONS:

Section 1. Requires the commissioner of health to conduct a study to

review the rates of reimbursement made through the New York state Medi-
caid durable equipment, orthotics, prosthetics and supplies program for
rate adequacy and patient access including those made under all capita-
tion and contract coverage models. Establishes the components of the
review.

Section 2. Establishes that one year after the effective date of this
act, the commissioner of health must submit a report of the findings and
recommendations to the governor, temporary president of the senate, the
speaker of the assembly and the chairs of the senate and assembly
committees on health. Establishes that the report must be posted on the
department of health's website.

Section 3. Authorizes the commissioner of health to promulgate rules and
regulations.

Section 4. Establishes the effective date and expiration of this act
upon the submission of the report.

 
JUSTIFICATION:

New York residents who are enrolled in the NY Medicaid program and are
in need of access to orthotic and prosthetic (O&P) care have been nega-
tively impacted by the stagnant NY Medicaid O&P reimbursement rates. On
average, NY Medicaid currently reimburses 67% of the prevailing Medicare
reimbursement, which is lower than the 75% national average.

The current law authorizes the Medicaid program to reimburse "orthotic
and prosthetic devices" at a rate that must not exceed the lower price
in the NY Medicaid DME Services Fee Schedule or the usual customary
price charged to the general public, and the reimbursement of items with
no price listed in the fee schedule must not exceed the lower of th
acquisition cost, plus 50% or the usually customary price charged to the
general public.

Reimbursement for the skilled services and devices needed by certified
orthotists and prosthetists for their patients is facilitated using
L-codes, which are billed at delivery and include the device, its fabri-
cation and ongoing follow-up care. However, the NY Medicaid reimburse-
ment for these devices have remained stagnant since 1987, failing to
keep up with the Medicare reimbursement rates.

This means there are an estimated 80 codes for orthotic and prosthetic
technologies that are not currently listed on the NY Medicaid fee sched-
ule and such technologies are not available for individuals who need
them. Individuals looking for devices not on the medicaid fee schedule
must pay out-of-pocket, which can often be extraordinarily burdensome.
Additionally, the stagnant reimbursement rates with inflation have led
to the closure of about 30 O&P practices across the State, leaving Medi-
caid enrollees with very limited options and no choice but to utilize
used devices or continue using ill-fitting devices, which is a safety
hazard.

This legislation requires the commissioner of health to conduct a study
to review the rates of reimbursement made through the New York state
Medicaid durable equipment, orthotics, prosthetics and supplies program
for rate adequacy and patient access including those made under all
capitation and contract coverage models. Vulnerable populations across
the State who are suffering from debilitating injuries, disease or birth
defects deserve to be treated as equals.  The State must investigate and
ensure parity which begins with an adequacy review of reimbursement
rates for orthotics and prosthetics.

 
FISCAL IMPLICATIONS:

TBD

 
EFFECTIVE DATE:
Immediately and shall expire and be deemed repealed upon the submission
of the report required pursuant to section two of this act.

2021-S7023 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7023
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               May 24, 2021
                                ___________
 
 Introduced  by  Sen. MANNION -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 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;
   (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11559-01-1

 S. 7023                             2
 
 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 speaker of the assembly and the chairs of the senate and
 assembly  committees on health and shall post such report on the depart-
 ment 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.

co-Sponsors

2021-S7023A (ACTIVE) - Details

See Assembly Version of this Bill:: A7892
Current Committee:: Assembly Ways And Means
Law Section:: Public Health
Versions Introduced in 2023-2024 Legislative Session:: S3131, A5113

2021-S7023A (ACTIVE) - Summary

2021-S7023A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7023A

SPONSOR: MANNION
 
TITLE OF BILL:

An act directing the commissioner of health to conduct a study on 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; and providing for the repeal of such
provisions upon expiration thereof

 
PURPOSE:

To conduct a study to review the rates of reimbursement made through the
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.

 
SUMMARY OF PROVISIONS:

Section 1. Requires the commissioner of health to conduct a study to
review the rates of reimbursement made through the New York state Medi-

caid durable equipment, orthotics, prosthetics and supplies program for
rate adequacy and patient access including those made under all capita-
tion and contract coverage models. Establishes the components of the
review.

Section 2. Establishes that one year after the effective date of this
act, the commissioner of health must submit a report of the findings and
recommendations to the governor, temporary president of the senate, the
speaker of the assembly and the chairs of the senate and assembly
committees on health. Establishes that the report must be posted on the
department of health's website.

Section 3. Authorizes the commissioner of health to promulgate rules and
regulations.

Section 4. Establishes the effective date and expiration of this act
upon the submission of the report.

 
JUSTIFICATION:

New York residents who are enrolled in the NY Medicaid program and are
in need of access to orthotic and prosthetic (O&P) care have been nega-
tively impacted by the stagnant NY Medicaid O&P reimbursement rates. On
average, NY Medicaid currently reimburses 67% of the prevailing Medicare
reimbursement, which is lower than the 75% national average.

The current law authorizes the Medicaid program to reimburse "orthotic
and prosthetic devices" at a rate that must not exceed the lower price
in the NY Medicaid DME Services Fee Schedule or the usual customary
price charged to the general public, and the reimbursement of items with
no price listed in the fee schedule must not exceed the lower of th
acquisition cost, plus 50% or the usually customary price charged to the
general public.

Reimbursement for the skilled services and devices needed by certified
orthotists and prosthetists for their patients is facilitated using
L-codes, which are billed at delivery and include the device, its fabri-
cation and ongoing follow-up care. However, the NY Medicaid reimburse-
ment for these devices have remained stagnant since 1987, failing to
keep up with the Medicare reimbursement rates.

This means there are an estimated 80 codes for orthotic and prosthetic
technologies that are not currently listed on the NY Medicaid fee sched-
ule and such technologies are not available for individuals who need
them. Individuals looking for devices not on the medicaid fee schedule
must pay out-of-pocket, which can often be extraordinarily burdensome.
Additionally, the stagnant reimbursement rates with inflation have led
to the closure of about 30 O&P practices across the State, leaving Medi-
caid enrollees with very limited options and no choice but to utilize
used devices or continue using ill-fitting devices, which is a safety
hazard.

This legislation requires the commissioner of health to conduct a study
to review the rates of reimbursement made through the New York state
Medicaid durable equipment, orthotics, prosthetics and supplies program
for rate adequacy and patient access including those made under all
capitation and contract coverage models. Vulnerable populations across
the State who are suffering from debilitating injuries, disease or birth
defects deserve to be treated as equals.  The State must investigate and
ensure parity which begins with an adequacy review of reimbursement
rates for orthotics and prosthetics.

 
FISCAL IMPLICATIONS:

TBD

 
EFFECTIVE DATE:
Immediately and shall expire and be deemed repealed upon the submission
of the report required pursuant to section two of this act.

2021-S7023A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7023--A
     Cal. No. 118
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               May 24, 2021
                                ___________
 
 Introduced  by Sens. MANNION, KENNEDY, REICHLIN-MELNICK, SKOUFIS -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee  on  Health  --  recommitted  to  the Committee on Health in
   accordance with Senate Rule 6, sec. 8 -- reported favorably from  said
   committee,  ordered  to  first  and  second report, ordered to a third
   reading, passed by Senate and delivered  to  the  Assembly,  recalled,
   vote  reconsidered,  restored  to  third  reading, amended and ordered
   reprinted, retaining its place in the 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;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11559-03-2
 S. 7023--A                          2

 
   (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;
   (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.

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Senate Bill S7023A

Share this bill

Sponsored By

John W. Mannion

Archive: Last Bill Status - In Assembly Committee

Bill Amendments

co-Sponsors

Timothy M. Kennedy

Elijah Reichlin-Melnick

James Skoufis

2021-S7023 - Details

2021-S7023 - Summary

2021-S7023 - Sponsor Memo

2021-S7023 - Bill Text download pdf

co-Sponsors

Timothy M. Kennedy

Elijah Reichlin-Melnick

James Skoufis

2021-S7023A (ACTIVE) - Details

2021-S7023A (ACTIVE) - Summary

2021-S7023A (ACTIVE) - Sponsor Memo

2021-S7023A (ACTIVE) - Bill Text download pdf

Comments