Bill Text: NY A07492 | 2019-2020 | 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: Strong Partisan Bill (Democrat 21-2)

Status: (Engrossed) 2019-06-14 - RETURNED TO ASSEMBLY [A07492 Detail]

Download: New_York-2019-A07492-Introduced.html

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                       May 7, 2019
        Introduced  by M. of A. STECK -- 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.
    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.

        A. 7492                             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.