(The Center Square) – As the New York State Legislature wraps up this week, providers of durable medical equipment hope lawmakers will take up their cause before the session ends.
A bill is before both chambers that would require Medicaid managed care organizations to pay durable medical equipment providers 100 percent of the fee schedule for equipment that can help keep patients at home instead of a hospital.
In other cases, durable medical equipment can help an individual function more independently and rely less on a caregiver to assist them.
Durable medical equipment runs the gamut ranging from wheelchairs and power mobility equipment to prosthetics to hospital beds to ventilators and oxygen systems.
The Northeast Medical Equipment Providers Association, which represents about 150 providers in the state, says a change is needed because the managed care organizations often reimburse at less than half the fee schedule. They may get even less if a third-party administrator is involved.
As a result, more than 20% of the durable medical equipment businesses in New York have closed, said John Quinlan, the association's president.
“There are 12 counties in New York that don't even have a DME provider,” said Quinlan, who is also president of Quinlan’s Pharmacy and Medical Equipment based in Wayland. “So when you're trying to get a patient out of the hospital for that walker. … If they can’t get out because there’s no DME provider, that’s a big deal.”
Other states, including Kentucky, North Carolina and Virginia, have passed fee-parity laws.
The bill, Senate Bill 5118/Assembly Bill 5368, has received a third reading in the Senate, but in the Assembly, it was sent to the Ways and Means Committee on May 20 after the Health Committee voted 22-4 to pass the bill.
State Sen. Gustavo Rivera, D-Bronx, sponsors the Senate bill. In his sponsor memo, he said that managed care organizations make up about 75 percent of the business for durable medical equipment providers.
Rivera, who also chairs the Senate Health Committee, also noted that the state requires such parity for behavioral health needs.
“Without reimbursement parity, additional DME providers will close and consumers will no longer be able to access medically necessary services,” Rivera wrote in the sponsor memo.