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Senate Co-Sponsorship Memoranda
Senate of Pennsylvania
Session of 2023 - 2024
Regular Session
MEMORANDUM
| Posted: | July 1, 2024 04:36 PM |
|---|---|
| From: | Senator Christine M. Tartaglione and Sen. Judy Ward, Sen. Frank A. Farry |
| To: | All Senate members |
| Subject: | Medicaid Fairness for Orthotics and Prosthetics |
| We will soon introduce legislation that updates Pennsylvania’s Medicaid fee schedule for Orthotic and Prosthetic (O&P) items and services. O&P items and services are essential to many Pennsylvanians of all ages and demographics, especially children and veterans, and have a substantial positive impact on patient health by increasing mobility, maximizing function, reducing pain, preventing further injury, and can often reduce future medical costs for patients. In spite of this, Medicaid Managed Care Organizations (MCOs) and Commercial Insurance companies reimburse O&P services at rates far below Medicare rates. While Medicare has increased its reimbursement for O&P devices by 17% over the last three years, the PA Medicaid reimbursement rates for O&P codes and services have not been materially updated since 1986. As a result, the average reimbursement rate for O&P services is 53% of Medicare in Pennsylvania. Neighboring states, including New York and West Virginia, boast higher Medicaid rates while states such as Massachusetts and Indiana have recently increased their rates to 90% and 100% of Medicare, respectively. Furthermore, over 150 codes under O&P services that are contained in Medicare’s fee schedule are absent from the PA Medicaid schedule, resulting in exemption processes that delay time-sensitive care. In this current environment, MCOs maintain the leverage to negotiate unsustainably low rates for O&P services. This strains the providers’ ability to deliver quality and efficient care such that our state’s Medicaid recipients are not able to receive the same O&P devices or services as they would under other insurance programs. Ultimately, if nothing changes, we risk an exodus of O&P providers from the Medicaid market and dwindling access to care for members of some of our most vulnerable populations. In turn, our legislation requires our state’s Medicaid fee schedule to match the reimbursement rates of the prevailing Medicare fee schedule as maintained by the Centers for Medicare and Medicaid Services for O&P items and services. Additionally, our legislation adds all O&P related codes contained on the prevailing Medicare fee schedule that are missing from the Medicaid fee schedule. Please join us in supporting access to O&P services for all Pennsylvanians by cosponsoring this legislation. |
Introduced as SB1288
Memo Updated: July 1, 2024 04:37 PM