I thank my friends at Richard Lau’s office for this one.
Many of us have battled non-listed DME viz CPM equipment. The argument that is raised is that the Medicaid fee schedule’s limitations (i.e. ground rules) does not apply to CPM since it is not in the Medicaid fee schedule. Thus, when an invoice is presented and the 1/6 of invoice cost divided by 30 formula is presented, Applicant vehemently argues and says the ground rule should not apply to the CPM provider since it is not in the fee schedule.
Applicant goes on and says that it is entitled to the U&C value, which “according to Inegnix” and the “high standard of living” in New York comes out to between $80-$88 per rental date. Some experts have presented affidavits that U&C can be $17-25 per rental date.
The Department of Health has written on this issue, and they have proclaimed that 1/6 of invoice cost divided by 30 is the proper reimbursement for CPM equipment. In the realm of no-fault litigation, proclamations of an administrative agency through informal letter will usually have prima facie effect on the issue at bar. LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co., 12 N.Y.3d 217 (2000)
2 Responses
Just read the letter. I’m confused. Where does the letter say that it ought to be divided by 30?
The good ole insurance company execs over at the Dept of Insurance like mobsters keeping their mouths shut in prison.
When you get out you get your reward … then you back … etc. The ole revolving door of corruption.
Then there is that ugly disgusting cowardly Wren — the head guy. When he got the job he said “I love politics.” I hope you end up in prison where you are repeatedly raped.