Mike Caputo, COA, NYAAOP Vice President gives an update on the latest in NY reimbursement issues. He'll be doing weekly updates for the foreseeable future.
Medicare Billing Resources
One on one electronic supplier visit request form
February 2023 - URGENT CALL TO ACTION!
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.