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 and complex rehabilitation technology 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: A2520
SPONSOR: McDonald (MS) 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 is to provide parity to durable medical equipment providers by
requiring Medicaid managed care organizations to reimburse such provid-
ers at no less than one hundred percent of the state's Medicaid durable
medical equipment and complex rehabilitation technology fee schedule for
the same services and supplies.
SUMMARY OF PROVISIONS:
Section one of the bill amends section 364-j of the social services law
to require Medicaid managed care organizations to reimburse durable
medical equipment providers at no less than one hundred percent of the
Medicaid durable medical equipment and complex rehabilitation technology
fee schedule for the same service or item of durable medical equipment,
prosthetics, orthotics, and supplies.
Section two establishes 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 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 Medi-
caid 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 pari-
ty, additional DME providers will close, and consumers will no longer be
able to access medically necessary services. The requirement of parity
has been enacted in other areas of the Medicaid 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: A.5368A/S.5118A
2023-2024: A.3408/S.3468
FISCAL IMPLICATIONS:
No fiscal impact to the state.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become law.
STATE OF NEW YORK
________________________________________________________________________
2520
2025-2026 Regular Sessions
IN ASSEMBLY
January 17, 2025
___________
Introduced by M. of A. McDONALD, LUPARDO, COLTON, SIMON, MAHER, McDO-
NOUGH, BUTTENSCHON, SAYEGH, STIRPE, GALLAHAN, NOVAKHOV, JACKSON, SHIM-
SKY, EACHUS, PAULIN, MORINELLO, ZACCARO, HEVESI, STECK, BENEDETTO,
BURDICK, SEAWRIGHT, PALMESANO, BICHOTTE HERMELYN, DeSTEFANO, TAYLOR,
WEPRIN, MEEKS, DINOWITZ, FITZPATRICK, McMAHON, ROSENTHAL, BRABENEC --
Multi-Sponsored by -- M. of A. LEVENBERG -- 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
and complex rehabilitation technology 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 and complex rehabilitation technology fee schedule for
7 the same service or item.
8 § 2. This act shall take effect on the ninetieth day after it shall
9 have become a law; provided, however, that the amendments to subdivision
10 4 of section 364-j of the social services law made by section one of
11 this act shall not affect the repeal of such section and shall be deemed
12 repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04119-01-5
