NY State Senate Bill 2019-S7569

Senate Bill S7569

2019-2020 Legislative Session

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

download bill text pdf

Archive: Last Bill Status - In Senate Committee Finance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 11, 2020	reported and committed to finance
Jan 27, 2020	referred to health

Votes

- Feb 11, 2020 - Health Committee Vote
  S7569
  
  10
  
  Aye
  
  2
  
  Nay
  
  3
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Feb 11, 2020
      
      aye (10)
      
      Benjamin
      
      Biaggi
      
      Carlucci
      
      Hoylman-Sigal
      
      Kaminsky
      
      Metzger
      
      Montgomery
      
      Rivera
      
      Salazar
      
      Stavisky
      
      nay (2)
      
      Gallivan
      
      Jacobs
      
      aye wr (3)
      
      Little
      
      Ortt
      
      Ritchie

2019-S7569 (ACTIVE) - Details

Current Committee:: Senate Finance
Law Section:: Social Services Law
Laws Affected:: Add §367-j, Soc Serv L

2019-S7569 (ACTIVE) - Summary

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

2019-S7569 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S7569

SPONSOR: SKOUFIS
 
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.

2019-S7569 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7569
 
                             I N  S E N A T E
 
                             January 27, 2020
                                ___________
 
 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:
 
   Section  1. The social services law is amended by adding a new section
 367-j to read as follows:
   § 367-J. COMPLEX REHABILITATION TECHNOLOGY; COVERAGE  AND  SAFEGUARDS.
 1.  DEFINITIONS. 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,
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD11457-02-9

 S. 7569                             2
 
 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 WHO HAS NO
 FINANCIAL   RELATIONSHIP  WITH  THE  COMPLEX  REHABILITATION  TECHNOLOGY
 SUPPLIER.
   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.
   §  2. This act shall take effect on the first of April next succeeding
 the date on which it shall have become a law.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.