S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4232
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 13, 2023
                                ___________
 
 Introduced  by  M.  of  A.  STECK,  BUTTENSCHON,  COLTON, CRUZ, DICKENS,
   EPSTEIN, REYES, L. ROSENTHAL, SANTABARBARA, SAYEGH, SEAWRIGHT,  SIMON,
   WEPRIN, WILLIAMS -- 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:
 
   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
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05515-01-3
 A. 4232                             2
 
 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 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.