The New York State Department of Financial Services (DFS) which is responsible for regulating the New York No-Fault regulatory system and arbitration process has issued an emergency amendment to Regulation 83 (11 NYCRR 68) also known as The No-Fault Regulations.
The link to that regulation is here:
https://www.dfs.ny.gov/industry_guidance/regulations/emergency_insurance
A clear reading of the new language in the regulations shows what I believe will be two impacts to DME providers in the No-Fault system.
Under the new regulatory language DME providers do NOT need to be a New York State Medicaid-enrolled supplier.
It also provides that the charges for DME that are not listed in the Worker’s Compensation Fee Schedule, as well as those listed as a zero cost due to a prior-authorization requirement, shall be limited to the lesser of 1) the acquisition cost plus 50%, or 2) the usual and customary charges.
In my experience, for most DME providers this means that business should continue as usual.
However, also, in my experience it means that we can anticipate new and strange denials during the claims review process, as well as new and strange arguments during the arbitration process.
As usual, this article is just hitting the highlights of those issues I have the time to comment on.
Legal advice is best sought directly from your trusted counsel.