Bill Text: NY S01832 | 2021-2022 | General Assembly | Introduced
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 1-0)
Status: (Introduced - Dead) 2022-02-01 - REPORTED AND COMMITTED TO FINANCE [S01832 Detail]
Download: New_York-2021-S01832-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1832 2021-2022 Regular Sessions IN SENATE January 16, 2021 ___________ Introduced by Sen. SKOUFIS -- read twice and ordered printed, and when printed to be committed 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, 22 and other specialized equipment such as standing frames and gait train- 23 ers and accessories. 24 (c) "Individually configured" means a device with a combination of 25 sizes, features, adjustments or modifications that are configured or 26 designed by a qualified complex rehabilitation technology supplier for a 27 specific individual by measuring, fitting, programming, adjusting or EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04256-01-1S. 1832 2 1 adapting the device so that the device is consistent with the individ- 2 ual's medical condition, physical and functional needs and capabilities, 3 body size, period of need and intended use as determined by an assess- 4 ment or evaluation by a qualified health care professional. 5 (d) "Qualified complex rehabilitation technology professional" means 6 an individual who is certified as an assistive technology professional 7 by a nationally-recognized rehabilitation engineering and assistive 8 technology society. 9 (e) "Qualified complex rehabilitation technology supplier" means a 10 company or entity that: 11 (i) is accredited by a nationally-recognized accrediting organization; 12 (ii) is an enrolled supplier for durable medical equipment under the 13 federal medicare program and the medical assistance program under this 14 title; 15 (iii) has at least one qualified complex rehabilitation technology 16 professional available to analyze the needs and capacities of complex 17 needs patients in consultation with a qualified health care professional 18 and participate in the selection of appropriate complex rehabilitation 19 technology and provide training in the proper use of the complex reha- 20 bilitation technology; 21 (iv) requires a qualified complex rehabilitation technology profes- 22 sional be physically present for the evaluation and determination of 23 appropriate complex rehabilitation technology for complex needs 24 patients; 25 (v) has the capability to provide service and repair by qualified 26 technicians for all complex rehabilitation technology it sells; 27 (vi) has at least one retail vending location within New York state; 28 and 29 (vii) provides written information regarding how to receive service 30 and repair of complex rehabilitation technology to the complex needs 31 patient prior to the ordering of such technology. 32 (f) "Qualified health care professional" means a health care profes- 33 sional licensed or otherwise authorized to practice under title eight of 34 the education law, acting within his or her scope of practice who has no 35 financial relationship with the complex rehabilitation technology 36 supplier. 37 2. Reimbursement and billing procedures. (a) The commissioner shall 38 maintain specific reimbursement and billing procedures under this title 39 for complex rehabilitation technology products to ensure that Medicaid 40 payments for such products permit adequate access to such products and 41 services for complex needs patients and take into account the signif- 42 icant resources, infrastructure, and staff needed. 43 (b) The commissioner shall monitor the addition of new billing codes 44 for complex rehabilitation technology by the medicare program and shall 45 expeditiously incorporate such codes under this subdivision. 46 (c) Where reimbursement rates for complex rehabilitation technology 47 products provided under section forty-four hundred three-f of the public 48 health law or section three hundred sixty-four-j of this title are 49 determined by a managed care organization, they shall be determined 50 consistent with this subdivision. The commissioner may establish minimum 51 benchmark reimbursement rates to be paid by managed care organizations 52 under this paragraph. 53 § 2. This act shall take effect on the first of April next succeeding 54 the date on which it shall have become a law.
