S T A T E O F N E W Y O R K
________________________________________________________________________
4557--A
2017-2018 Regular Sessions
I N S E N A T E
February 17, 2017
___________
Introduced by Sens. ORTT, LARKIN -- read twice and ordered printed, and
when printed to be committed to the Committee on Health -- reported
favorably from said committee and committed to the Committee on
Finance -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the social services law and the public health law, in
relation to Medicaid reimbursement for complex rehabilitation technol-
ogy for patients with complex medical needs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The social services law is amended by adding a new section
367-j to read as follows:
§ 367-J. COMPLEX REHABILITATION TECHNOLOGY; REIMBURSEMENT. 1. DEFI-
NITIONS. AS USED IN THIS SECTION:
(A) "COMPLEX NEEDS PATIENT" MEANS A MEDICAL ASSISTANCE ENROLLEE WITH
SIGNIFICANT PHYSICAL OR FUNCTIONAL IMPAIRMENT RESULTING FROM A MEDICAL
CONDITION OR DISEASE INCLUDING, BUT NOT LIMITED TO: SPINAL CORD INJURY,
TRAUMATIC BRAIN INJURY, CEREBRAL PALSY, MUSCULAR DYSTROPHY, SPINA BIFI-
DA, OSTEOGENESIS IMPERFECTA, ARTHROGRYPOSIS, AMYOTROPHIC LATERAL SCLERO-
SIS, MULTIPLE SCLEROSIS, DEMYELINATING DISEASE, MYELOPATHY, MYOPATHY,
PROGRESSIVE MUSCULAR ATROPHY, ANTERIOR HORN CELL DISEASE, POST-POLIO
SYNDROME, CEREBELLAR DEGENERATION, DYSTONIA, HUNTINGTON'S DISEASE,
SPINOCEREBELLAR DISEASE, AND CERTAIN TYPES OF AMPUTATION, PARALYSIS OR
PARESIS.
(B) "COMPLEX REHABILITATION TECHNOLOGY" MEANS PRODUCTS CLASSIFIED AS
DURABLE MEDICAL EQUIPMENT WITHIN THE MEDICARE PROGRAM THAT ARE INDIVID-
UALLY CONFIGURED FOR INDIVIDUALS TO MEET THEIR SPECIFIC AND UNIQUE
MEDICAL, PHYSICAL AND FUNCTIONAL NEEDS AND CAPACITIES FOR BASIC AND
FUNCTIONAL ACTIVITIES OF DAILY LIVING. SUCH PRODUCTS INCLUDE, BUT ARE
NOT LIMITED TO: INDIVIDUALLY CONFIGURED MANUAL AND POWER WHEELCHAIRS
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.
LBD04523-04-7
S. 4557--A 2
AND OTHER SPECIALIZED EQUIPMENT SUCH AS STANDING FRAMES AND GAIT TRAIN-
ERS AND ACCESSORIES.
(C) "INDIVIDUALLY CONFIGURED" MEANS A DEVICE WITH A COMBINATION OF
SIZES, FEATURES, ADJUSTMENTS OR MODIFICATIONS THAT ARE CONFIGURED OR
DESIGNED BY A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIER FOR A
SPECIFIC INDIVIDUAL BY MEASURING, FITTING, PROGRAMMING, ADJUSTING OR
ADAPTING THE DEVICE SO THAT THE DEVICE IS CONSISTENT WITH THE INDIVID-
UAL'S MEDICAL CONDITION, PHYSICAL AND FUNCTIONAL NEEDS AND CAPABILITIES,
BODY SIZE, PERIOD OF NEED AND INTENDED USE AS DETERMINED BY AN ASSESS-
MENT OR EVALUATION BY A QUALIFIED HEALTH CARE PROFESSIONAL.
(D) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL" MEANS
AN INDIVIDUAL WHO IS CERTIFIED AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL
BY A NATIONALLY-RECOGNIZED REHABILITATION ENGINEERING AND ASSISTIVE
TECHNOLOGY SOCIETY.
(E) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIER" MEANS A
COMPANY OR ENTITY THAT:
(I) IS ACCREDITED BY A NATIONALLY-RECOGNIZED ACCREDITING ORGANIZATION;
(II) IS AN ENROLLED SUPPLIER FOR DURABLE MEDICAL EQUIPMENT UNDER THE
FEDERAL MEDICARE PROGRAM AND THE MEDICAL ASSISTANCE PROGRAM UNDER THIS
TITLE;
(III) HAS AT LEAST ONE QUALIFIED COMPLEX REHABILITATION TECHNOLOGY
PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPACITIES OF COMPLEX
NEEDS PATIENTS IN CONSULTATION WITH A QUALIFIED HEALTH CARE PROFESSIONAL
AND PARTICIPATE IN THE SELECTION OF APPROPRIATE COMPLEX REHABILITATION
TECHNOLOGY AND PROVIDE TRAINING IN THE PROPER USE OF THE COMPLEX REHA-
BILITATION TECHNOLOGY;
(IV) REQUIRES A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFES-
SIONAL BE PHYSICALLY PRESENT FOR THE EVALUATION AND DETERMINATION OF
APPROPRIATE COMPLEX REHABILITATION TECHNOLOGY FOR COMPLEX NEEDS
PATIENTS;
(V) HAS THE CAPABILITY TO PROVIDE SERVICE AND REPAIR BY QUALIFIED
TECHNICIANS FOR ALL COMPLEX REHABILITATION TECHNOLOGY IT SELLS;
(VI) HAS AT LEAST ONE RETAIL VENDING LOCATION WITHIN NEW YORK STATE;
AND
(VII) PROVIDES WRITTEN INFORMATION REGARDING HOW TO RECEIVE SERVICE
AND REPAIR OF COMPLEX REHABILITATION TECHNOLOGY TO THE COMPLEX NEEDS
PATIENT PRIOR TO THE ORDERING OF SUCH TECHNOLOGY.
(F) "QUALIFIED HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROFES-
SIONAL LICENSED OR OTHERWISE AUTHORIZED TO PRACTICE UNDER TITLE EIGHT OF
THE EDUCATION LAW, ACTING WITHIN HIS OR HER SCOPE OF PRACTICE.
2. REIMBURSEMENT AND BILLING PROCEDURES. (A) THE COMMISSIONER SHALL
MAINTAIN SPECIFIC REIMBURSEMENT AND BILLING PROCEDURES UNDER THIS TITLE
FOR COMPLEX REHABILITATION TECHNOLOGY PRODUCTS TO ENSURE THAT MEDICAID
PAYMENTS FOR SUCH PRODUCTS PERMIT ADEQUATE ACCESS TO SUCH PRODUCTS AND
SERVICES FOR COMPLEX NEEDS PATIENTS AND TAKE INTO ACCOUNT THE SIGNIF-
ICANT RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED.
(B) THE COMMISSIONER SHALL MONITOR THE ADDITION OF NEW BILLING CODES
FOR COMPLEX REHABILITATION TECHNOLOGY BY THE MEDICARE PROGRAM AND SHALL
EXPEDITIOUSLY INCORPORATE SUCH CODES UNDER THIS SUBDIVISION.
(C) WHERE REIMBURSEMENT RATES FOR COMPLEX REHABILITATION TECHNOLOGY
PRODUCTS PROVIDED UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC
HEALTH LAW OR SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE ARE
DETERMINED BY A MANAGED CARE ORGANIZATION, THEY SHALL BE DETERMINED
CONSISTENT WITH THIS SUBDIVISION. THE COMMISSIONER MAY ESTABLISH MINIMUM
BENCHMARK REIMBURSEMENT RATES TO BE PAID BY MANAGED CARE ORGANIZATIONS
UNDER THIS PARAGRAPH.
S. 4557--A 3
§ 2. The public health law is amended by adding a new section 2512 to
read as follows:
§ 2512. COMPLEX REHABILITATION TECHNOLOGY; REIMBURSEMENT. 1. DEFI-
NITIONS. AS USED IN THIS SECTION:
(A) "COMPLEX NEEDS PATIENT" MEANS A CHILD HEALTH PLUS ENROLLEE WITH
SIGNIFICANT PHYSICAL OR FUNCTIONAL IMPAIRMENT RESULTING FROM A MEDICAL
CONDITION OR DISEASE INCLUDING, BUT NOT LIMITED TO: SPINAL CORD INJURY,
TRAUMATIC BRAIN INJURY, CEREBRAL PALSY, MUSCULAR DYSTROPHY, SPINA BIFI-
DA, OSTEOGENESIS IMPERFECTA, ARTHROGRYPOSIS, AMYOTROPHIC LATERAL SCLERO-
SIS, MULTIPLE SCLEROSIS, DEMYELINATING DISEASE, MYELOPATHY, MYOPATHY,
PROGRESSIVE MUSCULAR ATROPHY, ANTERIOR HORN CELL DISEASE, POST-POLIO
SYNDROME, CEREBELLAR DEGENERATION, DYSTONIA, HUNTINGTON'S DISEASE,
SPINOCEREBELLAR DISEASE, AND CERTAIN TYPES OF AMPUTATION, PARALYSIS OR
PARESIS.
(B) "COMPLEX REHABILITATION TECHNOLOGY" MEANS PRODUCTS CLASSIFIED AS
DURABLE MEDICAL EQUIPMENT WITHIN THE MEDICARE PROGRAM THAT ARE INDIVID-
UALLY CONFIGURED FOR INDIVIDUALS TO MEET THEIR SPECIFIC AND UNIQUE
MEDICAL, PHYSICAL AND FUNCTIONAL NEEDS AND CAPACITIES FOR BASIC AND
FUNCTIONAL ACTIVITIES OF DAILY LIVING. SUCH PRODUCTS INCLUDE, BUT ARE
NOT LIMITED TO: INDIVIDUALLY CONFIGURED MANUAL AND POWER WHEELCHAIRS
AND ACCESSORIES, ADAPTIVE SEATING AND POSITIONING ITEMS AND ACCESSORIES,
AND OTHER SPECIALIZED EQUIPMENT SUCH AS STANDING FRAMES AND GAIT TRAIN-
ERS AND ACCESSORIES.
(C) "INDIVIDUALLY CONFIGURED" MEANS A DEVICE WITH A COMBINATION OF
SIZES, FEATURES, ADJUSTMENTS OR MODIFICATIONS THAT ARE CONFIGURED OR
DESIGNED BY A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIER FOR A
SPECIFIC INDIVIDUAL BY MEASURING, FITTING, PROGRAMMING, ADJUSTING OR
ADAPTING THE DEVICE SO THAT THE DEVICE IS CONSISTENT WITH THE INDIVID-
UAL'S MEDICAL CONDITION, PHYSICAL AND FUNCTIONAL NEEDS AND CAPABILITIES,
BODY SIZE, PERIOD OF NEED AND INTENDED USE AS DETERMINED BY AN ASSESS-
MENT OR EVALUATION BY A QUALIFIED HEALTH CARE PROFESSIONAL.
(D) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL" MEANS
AN INDIVIDUAL WHO IS CERTIFIED AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL
BY A NATIONALLY-RECOGNIZED REHABILITATION ENGINEERING AND ASSISTIVE
TECHNOLOGY SOCIETY.
(E) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIER" MEANS A
COMPANY OR ENTITY THAT:
(I) IS ACCREDITED BY A NATIONALLY-RECOGNIZED ACCREDITING ORGANIZATION;
(II) IS AN ENROLLED SUPPLIER FOR DURABLE MEDICAL EQUIPMENT UNDER THE
FEDERAL MEDICARE PROGRAM AND THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE
ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW;
(III) HAS AT LEAST ONE QUALIFIED COMPLEX REHABILITATION TECHNOLOGY
PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPACITIES OF COMPLEX
NEEDS PATIENTS IN CONSULTATION WITH A QUALIFIED HEALTH CARE PROFESSIONAL
AND PARTICIPATE IN THE SELECTION OF APPROPRIATE COMPLEX REHABILITATION
TECHNOLOGY AND PROVIDE TRAINING IN THE PROPER USE OF THE COMPLEX REHA-
BILITATION TECHNOLOGY;
(IV) REQUIRES A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFES-
SIONAL BE PHYSICALLY PRESENT FOR THE EVALUATION AND DETERMINATION OF
APPROPRIATE COMPLEX REHABILITATION TECHNOLOGY FOR COMPLEX NEEDS
PATIENTS;
(V) HAS THE CAPABILITY TO PROVIDE SERVICE AND REPAIR BY QUALIFIED
TECHNICIANS FOR ALL COMPLEX REHABILITATION TECHNOLOGY IT SELLS;
(VI) HAS AT LEAST ONE RETAIL VENDING LOCATION WITHIN NEW YORK STATE;
AND
S. 4557--A 4
(VII) PROVIDES WRITTEN INFORMATION REGARDING HOW TO RECEIVE SERVICE
AND REPAIR OF COMPLEX REHABILITATION TECHNOLOGY TO THE COMPLEX NEEDS
PATIENT PRIOR TO THE ORDERING OF SUCH TECHNOLOGY.
(F) "QUALIFIED HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROFES-
SIONAL LICENSED OR OTHERWISE AUTHORIZED TO PRACTICE UNDER TITLE EIGHT OF
THE EDUCATION LAW, ACTING WITHIN HIS OR HER SCOPE OF PRACTICE.
2. REIMBURSEMENT AND BILLING PROCEDURES. (A) THE COMMISSIONER SHALL
MAINTAIN SPECIFIC REIMBURSEMENT AND BILLING PROCEDURES UNDER THIS TITLE
FOR COMPLEX REHABILITATION TECHNOLOGY PRODUCTS TO ENSURE THAT PAYMENTS
FOR SUCH PRODUCTS PERMIT ADEQUATE ACCESS TO SUCH PRODUCTS AND SERVICES
FOR COMPLEX NEEDS PATIENTS AND TAKE INTO ACCOUNT THE SIGNIFICANT
RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED.
(B) THE COMMISSIONER SHALL MONITOR THE ADDITION OF NEW BILLING CODES
FOR COMPLEX REHABILITATION TECHNOLOGY BY THE MEDICARE PROGRAM AND SHALL
EXPEDITIOUSLY INCORPORATE SUCH CODES UNDER THIS SUBDIVISION.
(C) WHERE REIMBURSEMENT RATES FOR COMPLEX REHABILITATION TECHNOLOGY
PRODUCTS PROVIDED UNDER THIS SECTION ARE DETERMINED BY AN APPROVED
ORGANIZATION, THEY SHALL BE DETERMINED CONSISTENT WITH THIS SUBDIVISION.
THE COMMISSIONER MAY ESTABLISH MINIMUM BENCHMARK REIMBURSEMENT RATES TO
BE PAID BY APPROVED ORGANIZATIONS UNDER THIS PARAGRAPH.
§ 3. This act shall take effect on the first of April next succeeding
the date on which it shall have become a law; provided that effective
immediately, the commissioner of health shall make regulations and take
other actions reasonably necessary to implement this act on or before
such date.
