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

2025 Regular Session Introduced by Jake Ashby and 34 co-sponsors

Requires Medicaid managed care plans in NY to reimburse DME, prosthetics, orthotics, and related supplies at no less than 100% of the Medical Assistance DME/Complex Rehab Fee Sched

SUBSTITUTED BY A10576

Overview

Bill S.8838 (2025-2026, New York) seeks to ensure parity in reimbursement for durable medical equipment (DME), prosthetics, orthotics, and related supplies by Medicaid managed care organizations (MCOs). The core directive is that MCOs must reimburse providers at no less than 100% of the Medical Assistance Durable Medical Equipment and Complex Rehabilitation Technology Fee Schedule for the same service or item.

Purpose and intent

Establish financial parity between DME providers and Medicaid managed care plans.

Address potential underpayment issues by requiring MCOs to reimburse at or above the standard fee schedule.

Ensure DME providers receive consistent, timely reimbursement for services and items covered under Medicaid.

Key provisions and changes

New requirement (added to Social Services Law, §364-j, subdivision 4, paragraph x):

Managed care providers must pay, directly or indirectly, for DME, prosthetics, orthotics, and related supplies at no less than 100% of the Medical Assistance DME and Complex Rehabilitation Technology Fee Schedule for the same service or item.

Scope:

Applies to durable medical equipment, prosthetics, orthotics, and related supplies furnished under Medicaid.

Effective date:

The act takes effect on the 90th day after it becomes law.
Note: The amendments to subdivision 4 of section 364-j are subject to the repeal of that section; the bill states the amendments do not alter such repeal and are deemed repealed alongside it (implies alignment with existing repeal process).

Who/what would be affected

Medicaid managed care organizations operating within New York State.

DME providers, including those supplying durable medical equipment, prosthetics, orthotics, and related supplies to Medicaid beneficiaries.

Potential indirect beneficiaries include Medicaid patients who rely on DME services, as reimbursement parity may affect access, acceptance of Medicaid plans by providers, and the availability of DME equipment.

Procedural and timeline aspects

Introduction and referral:

Introduced January 8, 2026; referred to the Senate Committee on Health.

Legislative progress (as listed in action history):

February–May 2026: Various committee actions, including amendments and re-refer actions (Health, Finance, Rules).
June 2026: Committee discharge and referral to Rules; order for third reading CAL.1735; substitution to A10576.

Effective date:

90 days after the bill becomes law.

Repeal interaction:

The bill notes that amendments to §364-j(4) do not affect repeal of that section and are repealed with it, indicating alignment with potential sunset or repeal timelines for the underlying statutory framework.

Potential impact and considerations

provider reimbursement: establishes a clear floor (100% of the fee schedule), which could improve cash flow and reduce denial rates for DME-related services.

patient access: could enhance access to necessary equipment due to more stable provider participation and reimbursement.

payer practices: may require MCOs to adjust payment workflows, auditing, and contracts with DME suppliers to ensure compliance with the 100% floor.

administrative burden: implicit need for MCOs and providers to track fee-schedule-based payments and ensure alignment with the standard schedule.

If you’d like, I can add a brief comparative note with current Medicaid reimbursement practices or provide a side-by-side of the bill’s language versus existing law for quick reference.