BILL NUMBER: S3131

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:

The purpose of this bill is 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, pros-
thetics and supplies program for rate adequacy and patient access.

 
SUMMARY OF PROVISIONS:

Section 1 of this bill would require 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. Establishes the
components of the review.

Section 2 of this bill would establish 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 and Legislative leaders,
and establish that the report must be posted on the Department of
Health's website.

Section 3 of this bill would authorize the Commissioner of Health to
promulgate rules and regulations.

Section 4 of this bill provides that the effective date 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effect immediately and shall expire and be deemed repealed upon the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.

 
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 the
acquisition costs, 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 forand prosthetics.

 
LEGISLATIVE HISTORY:

2021-22: S.7023-A (Mannion) - Repassed Senate.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
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.