January 2025

Tell your Senator & Assembly Member to
Co-sponsor and Prioritize Medicaid MCO Parity

Today, thousands of New Yorkers with Medicaid Managed Care Coverage living with limb loss, limb difference and other conditions causing mobility impairments are not afforded the same access to life-changing orthotic and prosthetic (O&P) care as those with other types of insurances. O&P items are part of Durable Medical Equipment and Orthotic & Prosthetic Supplies (DMEPOS), that help restore mobility, independence, ability to work/function as well as improve quality of life. A lack of Medicaid Parity negatively impacts all those who have DMEPOS needs for items such as bracing for arms, legs, spine, and/or head; artificial limbs; walkers, canes or wheelchairs; nebulizers; oxygen; and dressing aides, beds, lifts and commodes.

Bill S1616/A2520 (sponsored by Rivera and McDonald), seeks to address this pressing policy challenge. The joint bill provides parity to Medicaid beneficiaries by requiring managed care organizations to cover items at no less than one hundred percent of established NY Medicaid fee rates.

Please take a few minutes to fill out this form to automatically email your New York legislative leaders and tell them you support S1616/A2520. The more we make our voices heard, the more likely we are to create lasting, positive change.

Download and post this flyer in your office!

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Medicare Billing Resources

Clinician Checklists

Clinician Checklist for Ankle-Foot/Knee-Ankle-Foot Orthoses (noridianmedicare.com)

Clinician Checklist for Knee Orthoses - Custom and Prefabricated (noridianmedicare.com)

Clinician Checklist for Spinal Orthoses (noridianmedicare.com)

Clinician Checklist for Upper Limb Orthoses (noridianmedicare.com)

Clinician Checklist for Lower Limb Prostheses - Initial (noridianmedicare.com)

Clinician Checklist for Lower Limb Prostheses - Replacement (noridianmedicare.com)

Clinician Checklist for Therapeutic Shoes for Persons with Diabetes (noridianmedicare.com)

Clinician Letters

ANKLE-FOOT/KNEE-ANKLE-FOOT ORTHOSES Dear Clinician Letter (noridianmedicare.com)

DOCUMENTATION OF ARTIFICIAL LIMBS AND BRACES (OP) Dear Clinician Letter (noridianmedicare.com)

KNEE ORTHOSES Dear Clinician Letter (noridianmedicare.com)

DOCUMENTATION OF ARTIFICIAL LIMBS AND BRACES (OP) Dear Clinician Letter (noridianmedicare.com)

MEDICAL RECORDS Dear Clinician Letter (noridianmedicare.com)

THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: PHYSICIAN DOCUMENTATION REQUIREMENTS Dear Clinician Letter (noridianmedicare.com)

Documentation Checklists

Documentation Checklist for Ankle-Foot/Knee-Ankle-Foot Orthoses (noridianmedicare.com)

Documentation Checklist for Knee Orthoses (noridianmedicare.com)

Documentation Checklist for Spinal Orthoses (noridianmedicare.com)

Documentation Checklist for Upper Limb Orthoses (noridianmedicare.com)

Documentation Checklist for Lower Limb Prostheses (noridianmedicare.com)

Documentation Checklist for Therapeutic Shoes (noridianmedicare.com)

Education Resources

Schedule of Events - JA DME - Noridian (noridianmedicare.com)

DME On Demand Tutorials - JA DME - Noridian (noridianmedicare.com)

Webinar on Demand Recordings - JA DME - Noridian (noridianmedicare.com)

Orthotics - JA DME - Noridian (noridianmedicare.com)

Prosthetics - JA DME - Noridian (noridianmedicare.com)

Therapeutic Shoes - JA DME - Noridian (noridianmedicare.com)

One on one electronic supplier visit request form

Jurisdiction A (JA) Electronic Supplier Visit Data Collection Form (noridianmedicare.com)

Our Current
Initiatives

February 2023 - URGENT CALL TO ACTION!

S03468/A03408
Tell New York State Legislators to Support S03468/A03408!
Today, tens of thousands of New Yorkers enrolled in Medicaid MCOs living with limb loss, limb difference, and mobility impairments are unable to access life-changing orthotic and prosthetic (O&P) care, due to insufficient fee schedules that reimburse providers less than traditional Medicaid.

Without adequate reimbursement, O&P providers are unable to effectively serve their patients, forcing adults, children, and families to incur prohibitive out-of-pocket costs (ranging from $5,000-$50,000 per device), risk harm/injury using an improper device, or live sedentary lifestyles with costly health complications.

Senate Bill S03468 (sponsored by Senators Rivera, Gallivan, May, and Skoufis)/Assembly Bill A03408 (sponsored by Assembly members McDonald, Byrnes, Lupardo, Colton, Simon, and Gunther), seeks to address this pressing policy challenge.

These identical companion bills provide parity to Medicaid beneficiaries by requiring MCOs to cover items at no less than 100% of established NY Medicaid fee rates. Parity legislation of this type has already experienced widespread support across the country, with 20 states enacting similar legislation into law over the past 2 decades.

NY Workers Comp Policy Change

Under this change O&P providers would no longer be allowed to request prior authorization for their patients to workers’ comp; instead, the prior authorization paperwork must be completed by the patient’s prescribing doctor.