Provides 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 fee schedule for the same service or item.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A10576
SPONSOR: Lucas 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 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, at a minimum, reim-
burse such providers at Medicaid fee-for-service rates.
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, to require managed care providers to pay, directly or
indirectly, for durable medical equipment, prosthetics, orthotics, and
other related supplies at no less than one hundred percent of the Medi-
caid durable medical equipment fee schedule.
Section two of the bill provides 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, respiratory care
supplies, orthotics, and prosthetics. For Medicaid consumers with a
disability, DME can improve safety while decreasing the need for care-
giver 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 institu-
tional 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 in find-
ing 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 not survive 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: S5118-A Rivera/A5368-A McDonald
2023-2024: S3468 Rivera/A3408 McDonald
2025: S1616 Rivera/A2520 - Vetoed memo. 40
FISCAL IMPLICATIONS:
No fiscal.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become law.
STATE OF NEW YORK
________________________________________________________________________
10576
IN ASSEMBLY
March 13, 2026
___________
Introduced by M. of A. LUCAS -- read once and referred to the Committee
on Health
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
fee schedule for the same service or item
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 4 of section 364-j of the social services law
2 is amended by adding a new paragraph (x) to read as follows:
3 (x) Managed care providers shall pay, directly or indirectly, for
4 durable medical equipment, prosthetics, orthotics, and related supplies
5 at no less than one hundred percent of the medical assistance durable
6 medical equipment fee schedule for the same service or item.
7 § 2. This act shall take effect on the ninetieth day after it shall
8 have become a law; provided, however, that the amendments to subdivision
9 4 of section 364-j of the social services law made by section one of
10 this act shall not affect the repeal of such section and shall be deemed
11 repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04119-03-6
