A09003 Summary:

COSPNSRD'Urso, Dickens, Sayegh, Englebright, McDonald, Cruz, Colton, Buttenschon, Simon, Jaffee, Gottfried, Epstein, Santabarbara, Salka, Weprin, Rosenthal L, Seawright, Reyes, Lawrence, Williams, Miller ML, Niou
Add §367-j, Soc Serv L
Relates to coverage and billing procedures in the Medicaid program for complex rehabilitation technology for patients with complex medical needs.
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A09003 Actions:

01/10/2020referred to health
01/22/2020reported referred to ways and means
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A09003 Committee Votes:

HEALTH Chair:Gottfried DATE:01/22/2020AYE/NAY:25/0 Action: Favorable refer to committee Ways and Means

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A09003 Floor Votes:

There are no votes for this bill in this legislative session.
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A09003 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
  TITLE OF BILL: 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   PURPOSE OR GENERAL IDEA OF BILL: To maintain access to quality complex rehabilitation equipment for patients with specific diagnoses and physical conditions who require individually configured equipment and technology to sustain independence and avoid institutionalization. The bill will also safeguard the config- uration, delivery and repair of customized technology and equipment by establishing qualifications currently sought administratively through prior authorization and administrative review.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends the social service law by adding a new section, 367-j. Subdivision 1 defines complex needs patients and complex rehabilitation technology, as well as the required qualifications of individuals and entities eligible to configure and supply such equipment. Subdivision 2 directs the commissioner to monitor the addition of new billing codes for complex rehabilitation technology by the Medicare program and to expeditiously add these codes to the Medicaid program. Section 2 provides the effective date.   JUSTIFICATION: A small portion of the population depends on medically necessary, indi- vidually configured equipment, known as complex rehabilitation technolo- gy (CRT), to maintain their mobility, quality of life, and independence. CRT includes individually configured manual and power wheelchairs, adap- tive seating and position items, and other equipment designed to meet a patient's unique needs. For individuals with significant physical or functional impairments, having the appropriate equipment can mean the difference between constant pain and immobility and an active, fulfill- ing life. The existing process to qualify for and configure CRT for Medicaid bene- ficiaries, which this bill codifies, ensures that appropriately diag- nosed patients are able to access CRT, and that CRT suppliers meet stringent requirements to protect quality and access to service and repairs. Since CRT is a rapidly developing industry, the new technology often does not fit into existing durable medical equipment (DME) billing cate- gories. For example, a powered wheelchair with a custom-molded seat that supports the unique shape and pressure points of an individual with severe spinal curvature is not interchangeable with an off-the-shelf model that will cause sores, pain, and immobility. Thus, a crucial part of protecting access to this highly specialized equipment is keeping the billing codes used by Medicaid updated with the new codes added for CRT to the Medicare billing system. The timely addition of new billing codes that conform to Medicare changes will remove a hurdle many Medicaid beneficiaries face when trying to access the equipment they need.   PRIOR LEGISLATIVE HISTORY: 2017/18: A10604 passed Assembly Same as A.6120-B of 2018; Veto 165 Similar to A. 5074-C of 2016; Veto 270 2019: A7492/55741 passed both Assembly and Senate; Veto 142   FISCAL IMPLICATIONS: Undetermined.   EFFECTIVE DATE: The first of April next succeeding the date on which it shall have become law; provided that effective immediately, the commissioner of health shall make regulations and take other actions reasonably neces- sary to implement this act on that date.
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A09003 Text:

                STATE OF NEW YORK
                   IN ASSEMBLY
                                    January 10, 2020
        Introduced  by  M.  of  A.  STECK, D'URSO, DICKENS, SAYEGH, ENGLEBRIGHT,
          LAWRENCE, WILLIAMS, M. L. MILLER, NIOU -- 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,
    22  and other specialized equipment such as standing frames and gait  train-
    23  ers and accessories.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 9003                             2
     1    (c)  "Individually  configured"  means  a device with a combination of
     2  sizes, features, adjustments or modifications  that  are  configured  or
     3  designed by a qualified complex rehabilitation technology supplier for a
     4  specific  individual  by  measuring,  fitting, programming, adjusting or
     5  adapting  the  device so that the device is consistent with the individ-
     6  ual's medical condition, physical and functional needs and capabilities,
     7  body size, period of need and intended use as determined by  an  assess-
     8  ment or evaluation by a qualified health care professional.
     9    (d)  "Qualified  complex rehabilitation technology professional" means
    10  an individual who is certified as an assistive  technology  professional
    11  by  a  nationally-recognized  rehabilitation  engineering  and assistive
    12  technology society.
    13    (e) "Qualified complex rehabilitation  technology  supplier"  means  a
    14  company or entity that:
    15    (i) is accredited by a nationally-recognized accrediting organization;
    16    (ii)  is  an enrolled supplier for durable medical equipment under the
    17  federal medicare program and the medical assistance program  under  this
    18  title;
    19    (iii)  has  at  least  one qualified complex rehabilitation technology
    20  professional available to analyze the needs and  capacities  of  complex
    21  needs patients in consultation with a qualified health care professional
    22  and  participate  in the selection of appropriate complex rehabilitation
    23  technology and provide training in the proper use of the  complex  reha-
    24  bilitation technology;
    25    (iv)  requires  a  qualified complex rehabilitation technology profes-
    26  sional be physically present for the  evaluation  and  determination  of
    27  appropriate   complex   rehabilitation   technology  for  complex  needs
    28  patients;
    29    (v) has the capability to provide  service  and  repair  by  qualified
    30  technicians for all complex rehabilitation technology it sells;
    31    (vi)  has  at least one retail vending location within New York state;
    32  and
    33    (vii) provides written information regarding how  to  receive  service
    34  and  repair  of  complex  rehabilitation technology to the complex needs
    35  patient prior to the ordering of such technology.
    36    (f) "Qualified health care professional" means a health  care  profes-
    37  sional licensed or otherwise authorized to practice under title eight of
    38  the education law, acting within his or her scope of practice who has no
    39  financial   relationship  with  the  complex  rehabilitation  technology
    40  supplier.
    41    2. Reimbursement and billing procedures. (a)  The  commissioner  shall
    42  maintain  specific reimbursement and billing procedures under this title
    43  for complex rehabilitation technology products to ensure  that  Medicaid
    44  payments  for  such products permit adequate access to such products and
    45  services for complex needs patients and take into  account  the  signif-
    46  icant resources, infrastructure, and staff needed.
    47    (b)  The  commissioner shall monitor the addition of new billing codes
    48  for complex rehabilitation technology by the medicare program and  shall
    49  expeditiously incorporate such codes under this subdivision.
    50    (c)  Where  reimbursement  rates for complex rehabilitation technology
    51  products provided under section forty-four hundred three-f of the public
    52  health law or section three  hundred  sixty-four-j  of  this  title  are
    53  determined  by  a  managed  care  organization, they shall be determined
    54  consistent with this subdivision. The commissioner may establish minimum
    55  benchmark reimbursement rates to be paid by managed  care  organizations
    56  under this paragraph.

        A. 9003                             3
     1    §  2. This act shall take effect on the first of April next succeeding
     2  the date on which it shall have become a law.
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