BILL NUMBER: S3468

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to providing parity
to durable medical equipment providers by requiring Medicaid managed
care organizations to reimburse such providers at no less than one
hundred percent of the medical assistance durable medical equipment and
complex rehabilitation technology fee schedule for the same service or
item

 
PURPOSE:

This bill provides parity to durable medical equipment providers by
requiring Medicaid managed care organizations to reimburse such provid-
ers

 
SUMMARY OF PROVISIONS:

Section 1 amends subdivision 4 of section 364-j of the social services
law as it relates to the coverage of durable medical equipment and
              

related supplies. This section requires managed care providers to pay,
directly or indirectly, for durable medical equipment, prosthetics,
orthotics, and other related supplies.

Section two of the bill relates to the effective date.

 
JUSTIFICATION:

Durable Medical Equipment ("DME") is equipment that is considered
medically necessary as prescribed by a physician for use in a patient's
home. DME includes equipment such as wheelchairs, powered mobility
devices, hospital beds, oxygen systems, ventilators, and respiratory
care supplies, as well as orthotics and prosthetics. For Medicaid
consumers with a disability, DME can improve safety while decreasing the
need for caregiver assistance. It can substantially improve overall
quality of life by increasing a consumer's independence with functional
mobility and activities of daily living ("ADLs"). Medicaid members who
use DME services may regain independence in the hopes of returning to
their prior level of function and home environment rather than needing
costly institutional care.

In recent years, Medicaid managed care organizations (MCO) have reduced
reimbursement on DME products to unsustainable levels. Many MCOs reim-
burse DME providers less than half of the Medicaid fee-for-service fee
schedule for identical devices and supplies paid in the fee-for-service
system. This reimbursement reduction is compounded by the fact that the
majority of their members are enrolled in a Medicaid Managed Care Plan,
which comprises approximately 75 percent of their revenue.

This MCO rate reduction has caused numerous access issues throughout the
state. Medicaid consumers and their physicians face challenges finding a
DME supplier. Over 20 percent of providers have closed in recent years,
and twelve counties do not have a DME location. Without reimbursement
parity, additional DME providers will dose and consumers will no longer
be able to access medically necessary services and supplies.


The requirement of parity has been enacted in other areas of the Medi-
caid program, including behavioral health. In addition, other States
have implemented payment parity legislation and have established rate
floors, including Virginia, Kentucky, and North Carolina.

 
LEGISLATIVE HISTORY:

2021-2022: S5118A Rivera/A5368A McDonald

 
FISCAL IMPLICATIONS:

No fiscal

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become law.