S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5113
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 2, 2023
                                ___________
 
 Introduced  by M. of A. GUNTHER, SIMON, SAYEGH -- read once and referred
   to the Committee on Health
 
 AN ACT directing the commissioner of health to conduct a  study  on  the
   rates  of reimbursement made through the New York state Medicaid dura-
   ble medical equipment, orthotics, prosthetics and supplies program for
   rate adequacy and patient access; and providing for the repeal of such
   provisions upon expiration thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. The commissioner of health shall conduct a study to review
 the rates of reimbursement made through  the  New  York  state  Medicaid
 durable  medical  equipment, orthotics, prosthetics and supplies program
 for rate adequacy and patient access, including  those  made  under  all
 capitated and contract coverage models. Such review shall include:
   (a)  an  analysis of rules, regulations and policies for orthotics and
 prosthetics  service/device  provisions  under  the  New  York  Medicaid
 program, including all contracted and capitated models;
   (b)  a  comprehensive  assessment  of the existing methodology used to
 determine payment or nonpayment for prosthetic and orthotic care includ-
 ing but not limited to:
   (i) all orthotic and prosthetic codes  on  the  current  Medicaid  fee
 schedule,  including but not limited to a comparison of prevailing Medi-
 care fee schedule amounts and New York Medicaid amounts;
   (ii) codes on the Medicare fee schedule but not included  on  the  New
 York  state  Medicaid  durable medical equipment, orthotics, prosthetics
 and supplies program fee schedule;
   (iii)  recommendations  for  changing   reimbursement   methodologies.
 Recommendations under this subparagraph shall be consistent with federal
 law  and  shall include recommendations for appropriate changes in state
 law and regulations. Such  recommendations  shall  consider  appropriate
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04992-01-3
 A. 5113                             2
              

 
 payment  methodologies for codes not included on the Medicaid fee sched-
 ule;
   (c)  assessment  of  barriers  to  timely service provision as well as
 racial and socioeconomic disparities in access including, but not limit-
 ed to, travel time required, geographic variability, access to and  cost
 of technology;
   (d)  the  workforce needed to provide orthotic and prosthetic services
 in the next five years to eligible children and adults, disaggregated by
 county;
   (e) opportunities for stakeholder input on current rate methodologies;
 and
   (f) assessment of cost savings associated with percentage of  Medicaid
 population returning to work after orthotic and/or prosthetic provision.
   § 2. Within one year after the effective date of this act, the commis-
 sioner  of  health shall submit a report of the findings and recommenda-
 tions pursuant to this act to the governor, the temporary  president  of
 the senate, the minority leader of the senate, the speaker of the assem-
 bly,  the  minority  leader  of the assembly, and the chairs and ranking
 members of the senate and assembly committees on health and  shall  post
 such report on the department of health's website.
   §  3.  The  commissioner  of  health shall be authorized to promulgate
 rules and regulations to provide for the  orderly  effectuation  of  the
 provisions of this act.
   §  4.  This  act shall take effect immediately and shall expire and be
 deemed repealed upon the submission of the report required  pursuant  to
 section two of this act.