NEW YORK STATE ASSEMBLY
COMMITTEE ON HEALTH
COMMITTEE ON OVERSIGHT, ANALYSIS, AND INVESTIGATION
COMMITTEE ON SOCIAL SERVICES
TASK FORCE ON PEOPLE WITH DISABILITIES
DELAYS IN FUNDING OF DURABLE MEDICAL EQUIPMENT
Tuesday, July 19, 2005, 10:00 AM
Children and others with severe disabilities have been facing extraordinary delays in getting Medicaid approval for repairs or replacements for worn out or broken wheelchairs or for new equipment. These delays can make it impossible for people to get to work and can cause prolonged pain, damage to health, and physical injury.
Medicaid funding of "durable medical equipment" (DME) requires prior approval by the state Department of Health (DOH). The DOH Regional Medicaid Office in New York City, which handled all of the funding requests for New York City and Long Island, was closed in November 2004, with little public notice. Operations were moved to Albany. However, DOH admits it did not prepare staff for this change. As a result, a large backlog of funding requests was amassed. The Albany office has also been rejecting a large volume of applications, and is also frequently requiring additional and often unnecessary or duplicative information
In February, the Assembly Committee chairs met with DOH representatives and were assured that DOH was working to resolve the problems. However, significant problems, and possible violations of DOH regulations, remain. For example:
1) It takes too long to process requests. State regulations require DOH to issue a determination within 21 days, although providers report many claims extend beyond 21 days. Also, the rules now allow DOH to stop the 21-day clock simply by asking the applicant for more information. Many applicants report claims are returned three to four times before being approved or denied.
2) Guidelines are not clear. Despite a state rule that DOH make determinations based upon objective criteria and written guidelines, providers/vendors report they are unsure about the information they must submit in requests and what items DOH will approve.
3) DOH reviewers may be unqualified to assess what treatment and equipment is necessary.
Some of the issues witnesses may want to address are:
Persons wishing to attend or present testimony at this hearing should complete and return the reply form as soon as possible, but no later than July 13, 2005. It is important the form be fully completed and returned so persons may be notified in the event of postponement or cancellation of the hearing.
Oral testimony will be limited to ten minutes in length. All testimony is under oath. In preparing the order of witnesses, the Committee will attempt to accommodate individual requests to speak at particular times in view of special circumstances. This request should be made on the attached reply form or communicated to Committee staff as soon as possible. Ten copies of any prepared statement should be submitted at the hearing registration table.
In order to meet the needs of those who may have a disability, the New York State Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.
Questions about this hearing may be directed to Kathleen Fazio of the Assembly Oversight, Analysis and Investigation Committee staff at 518-455-4869 or firstname.lastname@example.org.
DELAYS IN FUNDING OF DURABLE MEDICAL EQUIPMENT FOR PEOPLE WITH SEVERE DISABILITIES
REPLY FORM - PLEASE RESPOND BY WEDNESDAY, JULY 13, 2005
Mail to: Assembly Oversight, Analysis and Investigation Committee,
|I plan to testify at the July 19 hearing on DOH delays in funding of durable medical equipment for people with severe disabilities.|
|I plan to attend, but not testify, at the July 19 hearing on DOH delays in funding of durable medical equipment for people with severe disabilities.|
I will require assistance and/or handicapped accessibility information. Please specify type of assistance required:
|Organization (if any):|
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