S.5118-A/A.5368-A would require Medicaid managed care organizations (MCOs) to reimburse DME providers at no less than 100% of the state’s published Medicaid durable medical equipment and complex rehabilitation technology fee schedule for the same services and supplies. This is necessary to ensure access to durable medical equipment is protected for Medicaid members who rely on this equipment, including wheelchairs, powered mobility devices, hospital beds, oxygen systems, ventilators and respiratory care supplies, as well as orthotics and prosthetics.
In recent years, Medicaid managed care organizations have reduced reimbursement on DME products to unsustainable levels. Many MCOs reimburse 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.
By enacting S.5118-A (Rivera)/A.5368-A (McDonald) there would be no cost to the State’s Medicaid program. Any cost increases by requiring Medicaid Managed Care Plans to reimburse DME providers at no less than 100% of the State’s DME and complex rehabilitation technology fee schedule for the same services and supplies would be offset by decreasing utilization in ER and hospitalization. Moreover, any increase to MMC plans would be minimal and should not require an actuarial adjustment.
We urge passage of S.5118-A (Rivera)/A.5368-A (McDonald), a bill that will enable DME providers to continue to provide quality products and services to families and individuals covered by Medicaid in New York.
The Northeast Medical Equipment Providers Association (NEMEP) and American Association for Homecare (AAHomecare) would like to thank Senator Gustavo Rivera, Assembly Member John McDonald III, and Assembly Member Richard Gottfried for their support.
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