Great News for New York CPAP Suppliers!

Published in Government Relations on July 18, 2022

State Update

This is a great example of a state association's hard at work. Congratulations on the win NEMEP! If you are not currently a member of your state association, you should be. This is how to get things accomplished. 

Beth Bowen, Executive Director of NEMEP says, “Because of your membership and support, NEMEP’s strength pays off!  Your NEMEP Medicaid committee continues to work hard on relationships with the NY and NJ Medicaid departments.  Last month NEMEP scored a BIG win for New York!  CPAP payments are now unbundled.”

Read this article from HME News for more information:

Medicaid Unbundles CPAP Payments in New York

With increased costs and surcharges weighing on providers, the recent decision by New York state Medicaid to unbundle CPAP and BiPAP supplies is “a big win,” say stakeholders. 

“Anything we can do to level that playing field and unbundle those supplies – it’s added reimbursement,” said David Chandler, senior director of payer relations for AAHomecare and chair of NEMEP’s Payer Relations Committee, which worked with Medicaid officials to get the change implemented.  

Prior to June 1, when the new policy took effect, reimbursement for a CPAP device was $496.20 and a full-face mask was $143.21, including headgear tubing and filters, making the total for a new set-up $639.41. 

Unbundled, that total is $826.04, a gain of $186.63. 

“It’s a big win,” said John Quinlan, NEMEP president. 

Stakeholders told state officials that, with a large population of Medicaid recipients enrolled under managed care organizations, which can pay even less, access to CPAP therapy was at risk. 

“We had a call where we talked about the increased prices with CPAP and BiPAP and everything that’s going on and we told them we’re not going to be able to afford to provide Medicaid members with CPAP because of the costs and because they pay low rates,” said Quinlan. 

Adding to the squeeze: Some MCOs weren’t covering heated humidifiers, because the Medicaid manual didn’t clearly define whether they were included as part of a bundle or paid separately, says Quinlan. Even when they were paid for, heated humidifiers were typically down coded and paid at the rate for unheated humidifiers, representing a cut of about 50%, Quinlan says. 

“Not only is this a win for fee-for-service, but also Medicaid managed care organizations now have to pay for humidifiers,” he said.

View HME News article here!


TAGS

  1. billing & reimbursement
  2. state association
  3. vgm
  4. vgm government

From Our Experts

The Return of Competitive Bidding thumbnail The Return of Competitive Bidding The Centers for Medicare & Medicaid Services (CMS) appear to be laying the groundwork for another round of the Competitive Bidding Program (CBP). While full implementation will take a couple of years, an official announcement is expected this summer—potentially as early as July. Out With The Old RAC, In With The New thumbnail Out With The Old RAC, In With The New On April 28, 2025, CMS awarded Cotiviti GOV Services LLC, the new RAC Recovery Audit Contractor (RAC) Region 3, 4, and 5 contracts. RAC Region 3 includes the following Medicare Administrative Contractor (MAC) jurisdictions: JJ, JM, and JN. RAC Region 4 includes jurisdictions: JE, JF, and JL. And RAC Region 5 includes jurisdictions: JA, JB, JC, JD, as well as the HH/H MACs: J6, J15, JK, and JM. Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? thumbnail Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? At VGM Group, Inc. we have the pleasure of serving our members and partners throughout the country.  One of the many ways we do this is through legislative advocacy, working with our partners to create a more equitable and effective healthcare system. All our VGM units are dedicated to advancing our partners' businesses, streamlining operations, and working every day to enhance reimbursement for the quality in-home healthcare our industry provides all people. Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award thumbnail Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award Last week, during the 2025 AAHomecare Washington Legislative Conference, Mike Hamilton, Executive Director of ADMEA, was honored with the prestigious Mal Mixon Advocate Award. VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference thumbnail VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference This week, VGM leaders attended the AAHomecare Legislative Conference in Washington, D.C., a premier event dedicated to advancing healthcare policy and advocacy. AAHomecare provided attendees with valuable insights, equipping them with key discussion points and strategies for effective meetings with legislators. Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia thumbnail Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia On Thursday, May 8, Paula Vineyard, owner of Elana Health & Loop Medical, took a pivotal step in healthcare advocacy by hosting a meeting with Tyler Ohrn, Field Representative for Congresswoman Carol Miller of West Virginia's First District. The hour-long discussion centered on the pressing need for congressional support of H.R. 2005. Manufacturer Survey On Tariffs thumbnail Manufacturer Survey On Tariffs The American Association for Homecare and VGM Group are seeking valuable insights from durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) manufacturers and vendor partners regarding tariffs imposed on certain countries. Key Payers Denied Your Application Citing Their Network Is Closed – Now What? thumbnail Key Payers Denied Your Application Citing Their Network Is Closed – Now What? This experience has increasingly become one of the most common questions we receive from our provider members as more and more payers move to narrow their provider networks. The reasons payers seek to narrow their networks are simple. Payers are highly motivated to achieve their goals while doing less work and are not required to allow providers into their networks unless there is a patient access issue. For those of you fortunate enough to be a part of a narrow network, this may not be much of