Provides parity to durable medical equipment providers by requiring Medicaid managed care organizations to reimburse such providers

• Democratic57
• Republican31

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

Durable Medical Equipment (DME) is equipment that is considered medically necessary as prescribed by a physician for use in a patient's home. DME includes equipment such as wheelchairs, powered mobility devices, hospital beds, oxygen systems, ventilators, respiratory care supplies, orthotics, and prosthetics. For Medicaid consumers with a disability, DME can improve safety while decreasing the need for care- giver assistance. It can substantially improve overall quality of life by increasing a consumer's independence with functional mobility and activities of daily living (ADLs). Medicaid members who use DME services may regain independence in the hopes of returning to their prior level of function and home environment rather than needing costly institu- tional care. In recent years, Medicaid managed care organizations (MCO) have reduced reimbursement on DME products to unsustainable levels. Many MCOs reim- burse 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. This reimbursement reduction is compounded by the fact that the majority of their members are enrolled in a Medicaid Managed Care Plan, which comprises approximately 75 percent of their revenue. This MCO rate reduction has caused numerous access issues throughout the state. Medicaid consumers and their physicians face challenges in find- ing a DME supplier. Over 20 percent of providers have closed in recent years, and twelve counties do not have a DME location. Without reimbursement parity, additional DME providers will not survive and consumers will no longer be able to access medically necessary services and supplies. The requirement of parity has been enacted in other areas of the Medi- caid program, including behavioral health. In addition, other States have implemented payment parity legislation and have established rate floors, including Virginia, Kentucky, and North Carolina.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.