Bill Text: NY A00646 | 2025-2026 | General Assembly | Introduced

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Bill Title: Relates to coverage and billing procedures in the Medicaid program for complex rehabilitation technology for patients with complex medical needs.

Spectrum: Partisan Bill (Democrat 14-0)

Status: (Introduced) 2025-01-08 - referred to health [A00646 Detail]

Download: New_York-2025-A00646-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                           646

                               2025-2026 Regular Sessions

                   IN ASSEMBLY

                                       (Prefiled)

                                     January 8, 2025
                                       ___________

        Introduced by M. of A. STECK, BUTTENSCHON, COLTON, CRUZ, EPSTEIN, REYES,
          ROSENTHAL,  SANTABARBARA,  SAYEGH, SEAWRIGHT, SIMON, WEPRIN, WILLIAMS,
          KELLES -- read once and referred to the Committee on Health

        AN ACT to amend the social services law, in  relation  to  coverage  and
          billing  procedures in the Medicaid program for complex rehabilitation
          technology for patients with complex medical needs

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1. The social services law is amended by adding a new section
     2  367-j to read as follows:
     3    § 367-j. Complex rehabilitation technology; coverage  and  safeguards.
     4  1.  Definitions. As used in this section:
     5    (a)  "Complex  needs patient" means a medical assistance enrollee with
     6  significant physical or functional impairment resulting from  a  medical
     7  condition  or disease including, but not limited to: spinal cord injury,
     8  traumatic brain injury, cerebral palsy, muscular dystrophy, spina  bifi-
     9  da, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclero-
    10  sis,  multiple  sclerosis,  demyelinating disease, myelopathy, myopathy,
    11  progressive muscular atrophy, anterior  horn  cell  disease,  post-polio
    12  syndrome,   cerebellar  degeneration,  dystonia,  huntington's  disease,
    13  spinocerebellar disease, and certain types of amputation,  paralysis  or
    14  paresis.
    15    (b)  "Complex  rehabilitation technology" means products classified as
    16  durable medical equipment within the medicare program that are  individ-
    17  ually  configured  for  individuals  to  meet  their specific and unique
    18  medical, physical and functional needs  and  capacities  for  basic  and
    19  functional  activities  of  daily living. Such products include, but are
    20  not limited to:  individually configured manual  and  power  wheelchairs
    21  and accessories, adaptive seating and positioning items and accessories,

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02178-01-5
        A. 646                              2

     1  and  other specialized equipment such as standing frames and gait train-
     2  ers and accessories.
     3    (c)  "Individually  configured"  means  a device with a combination of
     4  sizes, features, adjustments or modifications  that  are  configured  or
     5  designed by a qualified complex rehabilitation technology supplier for a
     6  specific  individual  by  measuring,  fitting, programming, adjusting or
     7  adapting the device so that the device is consistent with  the  individ-
     8  ual's medical condition, physical and functional needs and capabilities,
     9  body  size,  period of need and intended use as determined by an assess-
    10  ment or evaluation by a qualified health care professional.
    11    (d) "Qualified complex rehabilitation technology  professional"  means
    12  an  individual  who is certified as an assistive technology professional
    13  by a  nationally-recognized  rehabilitation  engineering  and  assistive
    14  technology society.
    15    (e)  "Qualified  complex  rehabilitation  technology supplier" means a
    16  company or entity that:
    17    (i) is accredited by a nationally-recognized accrediting organization;
    18    (ii) is an enrolled supplier for durable medical equipment  under  the
    19  federal  medicare  program and the medical assistance program under this
    20  title;
    21    (iii) has at least one  qualified  complex  rehabilitation  technology
    22  professional  available  to  analyze the needs and capacities of complex
    23  needs patients in consultation with a qualified health care professional
    24  and participate in the selection of appropriate  complex  rehabilitation
    25  technology  and  provide training in the proper use of the complex reha-
    26  bilitation technology;
    27    (iv) requires a qualified complex  rehabilitation  technology  profes-
    28  sional  be  physically  present  for the evaluation and determination of
    29  appropriate  complex  rehabilitation  technology   for   complex   needs
    30  patients;
    31    (v)  has  the  capability  to  provide service and repair by qualified
    32  technicians for all complex rehabilitation technology it sells;
    33    (vi) has at least one retail vending location within New  York  state;
    34  and
    35    (vii)  provides  written  information regarding how to receive service
    36  and repair of complex rehabilitation technology  to  the  complex  needs
    37  patient prior to the ordering of such technology.
    38    (f)  "Qualified  health care professional" means a health care profes-
    39  sional licensed or otherwise authorized to practice under title eight of
    40  the education law, acting within such health care  professional's  scope
    41  of practice who has no financial relationship with the complex rehabili-
    42  tation technology supplier.
    43    2.  Reimbursement  and  billing procedures. (a) The commissioner shall
    44  maintain specific reimbursement and billing procedures under this  title
    45  for  complex  rehabilitation technology products to ensure that Medicaid
    46  payments for such products permit adequate access to such  products  and
    47  services  for  complex  needs patients and take into account the signif-
    48  icant resources, infrastructure, and staff needed.
    49    (b) The commissioner shall monitor the addition of new  billing  codes
    50  for  complex rehabilitation technology by the medicare program and shall
    51  expeditiously incorporate such codes under this subdivision.
    52    (c) Where reimbursement rates for  complex  rehabilitation  technology
    53  products provided under section forty-four hundred three-f of the public
    54  health  law  or  section  three  hundred  sixty-four-j of this title are
    55  determined by a managed care  organization,  they  shall  be  determined
    56  consistent with this subdivision. The commissioner may establish minimum
        A. 646                              3

     1  benchmark  reimbursement  rates to be paid by managed care organizations
     2  under this paragraph.
     3    §  2. This act shall take effect on the first of April next succeeding
     4  the date on which it shall have become a law.