assembly Bill A7527

Amended

Requires specific Medicaid insurance codes related to complex needs patients' therapy and treatment; requires managed care contracts to comply with certain reimbursement rates

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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  • 23 / May / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • REFERRED TO HEALTH
  • 16 / May / 2014
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 16 / May / 2014
    • PRINT NUMBER 7527A
  • 02 / Jun / 2014
    • REPORTED REFERRED TO WAYS AND MEANS

Summary

Establishes the "complex needs patient act" including definitions and reimbursement and billing procedures; preserves access to quality complex rehabilitation technology for patients with complex medical needs.

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Bill Details

Versions:
A7527
A7527A
Legislative Cycle:
2013-2014
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Add §23, Pub Health L; add §4806, Ins L
view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7527

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              May 23, 2013
                               ___________

Introduced  by  M.  of  A. McDONALD, LAVINE, MAISEL, MONTESANO -- Multi-
  Sponsored by -- M. of A.  DUPREY, GABRYSZAK, ROSA, SIMANOWITZ --  read
  once and referred to the Committee on Health

AN ACT to amend the public health law, in relation to requiring specific
  Medicaid  insurance  codes  related to complex needs patients' therapy
  and treatment; and to amend the insurance law, in relation to  requir-
  ing  managed care contracts to comply with certain reimbursement rates
  related to complex needs patients' therapy and treatment

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Short  title. This act shall be known and may be cited as
the "complex needs patient act".
  S 2. Legislative intent. It is the intent of the Legislature to:
  a. protect access for complex needs patients to  important  technology
and supporting services;
  b.  establish  and  improve  safeguards  relating  to the delivery and
provision of medically necessary complex rehabilitation technology;
  c. provide supports for complex needs patients to stay in the home  or
community  setting, prevent institutionalization, and prevent hospitali-
zations and other costly secondary complications; and
  d. establish adequate pricing for  complex  rehabilitation  technology
for the purpose of allowing continued access to appropriate products and
services.
  S  3.  The  public health law is amended by adding a new section 23 to
read as follows:
  S 23. COMPLEX NEEDS PATIENT BENEFITS. 1. DEFINITIONS. AS USED IN  THIS
SECTION:  (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH A DIAGNO-
SIS OR MEDICAL CONDITION THAT RESULTS IN SIGNIFICANT PHYSICAL  OR  FUNC-
TIONAL  NEEDS  AND CAPACITIES.  SUCH TERM SHALL INCLUDE INDIVIDUALS WITH
PROGRESSIVE OR DEGENERATIVE NEUROMUSCULAR DISEASES OR INJURIES OR TRAUMA
WHICH RESULTED IN SIGNIFICANT PHYSICAL OR FUNCTIONAL NEEDS  AND  CAPACI-
TIES,  INCLUDING, BUT NOT LIMITED TO, INDIVIDUALS WITH SPINAL CORD INJU-
RY, TRAUMATIC BRAIN INJURY, CEREBRAL PALSY,  MUSCULAR  DYSTROPHY,  SPINA
BIFIDA,  OSTEOGENESIS  IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC LATERAL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10590-02-3

A. 7527                             2

SCLEROSIS, MULTIPLE SCLEROSIS, DEMYELINATING DISEASE, MYELOPATHY, MYOPA-
THY, PROGRESSIVE MUSCULAR ATROPHY, ANTERIOR HORN CELL DISEASE,  POST-PO-
LIO  SYNDROME,  CEREBELLAR DEGENERATION, DYSTONIA, HUNTINGTON'S DISEASE,
SPINOCEREBELLAR  DISEASE, AND CERTAIN TYPES OF AMPUTATION, PARALYSIS, OR
PARESIS THAT RESULT IN SIGNIFICANT  PHYSICAL  OR  FUNCTIONAL  NEEDS  AND
CAPACITIES.
  (B)  "COMPLEX REHABILITATION TECHNOLOGY" MEANS ITEMS CURRENTLY CLASSI-
FIED BY THE CENTERS FOR MEDICARE AND MEDICAID  SERVICES  AS  OF  JANUARY
FIRST, TWO THOUSAND THIRTEEN AS DURABLE MEDICAL EQUIPMENT THAT ARE INDI-
VIDUALLY  CONFIGURED  FOR  INDIVIDUALS TO MEET THEIR SPECIFIC AND UNIQUE
MEDICAL, PHYSICAL, AND FUNCTIONAL NEEDS AND CAPACITIES FOR BASIC  ACTIV-
ITIES  OF DAILY LIVING AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING IDEN-
TIFIED AS MEDICALLY NECESSARY TO PREVENT HOSPITALIZATION OR INSTITUTION-
ALIZATION OF A COMPLEX NEEDS PATIENT. SUCH ITEMS SHALL INCLUDE, BUT  NOT
BE  LIMITED TO, COMPLEX REHABILITATION POWER WHEELCHAIRS, HIGHLY CONFIG-
URABLE MANUAL WHEELCHAIRS, ADAPTIVE SEATING AND POSITIONING SYSTEMS, AND
OTHER SPECIALIZED EQUIPMENT SUCH AS STANDING FRAMES AND  GAIT  TRAINERS.
THE  RELATED  HEALTHCARE  COMMON  PROCEDURE  CODE SYSTEM (HCPCS) BILLING
CODES INCLUDE, BUT ARE NOT LIMITED TO:
  (1) PURE COMPLEX REHAB  TECHNOLOGY  (CRT)  CODES:  THESE  HCPCS  CODES
CONTAIN  100%  CRT  PRODUCTS:  E0637, E0638, E0641, E0642, E0986, E1002,
E1003, E1004, E1005, E1006, E1007, E1008, E1009,  E1010,  E1011,  E1014,
E1037,  E1161,  E1220,  E1228, E1229, E1231, E1232, E1233, E1234, E1235,
E1236, E1237, E1238, E1239, E2209, E2291, E2292,  E2293,  E2294,  E2295,
E2300,  E2301,  E2310,  E2311, E2312, E2313, E2321, E2322, E2323, E2324,
E2325, E2326, E2327, E2328, E2329, E2330, E2331,  E2351,  E2373,  E2374,
E2376,  E2377,  E2609,  E2610, E2617, E8000, E8001, E8002, K0005, K0835,
K0836, K0837, K0838, K0839, K0840, K0841, K0842,  K0843,  K0848,  K0849,
K0850,  K0851,  K0852,  K0853, K0854, K0855, K0856, K0857, K0858, K0859,
K0860, K0861, K0862, K0863, K0864, K0868, K0869,  K0870,  K0871,  K0877,
K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, AND K0898.
  (2)  MIXED  CRT CODES: THESE HCPCS CODES CONTAIN A MIX OF CRT PRODUCTS
AND STANDARD MOBILITY  AND  ACCESSORY  PRODUCTS:  E0950,  E0951,  E0952,
E0955,  E0956,  E0957,  E0958, E0960, E0967, E0978, E0990, E1015, E1016,
E1028, E1029, E1030, E2205, E2208, E2231, E2368,  E2369,  E2370,  E2605,
E2606,  E2607,  E2608,  E2613, E2614, E2615, E2616, E2620, E2621, E2624,
E2625, K0004, K0009, K0040, K0108, AND K0669.
  (3) FUTURE CODES CREATED TO EXPAND ON OR REPLACE  THOSE  INDICATED  IN
SUBPARAGRAPHS ONE AND TWO OF THIS PARAGRAPH.
  (C) "INDIVIDUALLY CONFIGURED" MEANS A COMBINATION OF FEATURES, ADJUST-
MENTS,  OR  MODIFICATIONS A SUPPLIER MAKES TO A DEVICE THAT ARE SPECIFIC
TO AN INDIVIDUAL AND THAT THE SUPPLIER PROVIDES BY  MEASURING,  FITTING,
PROGRAMMING,  ADJUSTING,  OR  ADAPTING THE DEVICE AS APPROPRIATE SO THAT
THE DEVICE IS CONSISTENT WITH AN ASSESSMENT OR EVALUATION OF  THE  INDI-
VIDUAL  BY  A  HEALTH CARE PROFESSIONAL AND CONSISTENT WITH THE INDIVID-
UAL'S MEDICAL CONDITION, PHYSICAL AND FUNCTIONAL NEEDS, CAPACITIES, BODY
SIZE, PERIOD OF NEED, AND INTENDED USE.
  (D) "QUALIFIED COMPLEX REHABILITATION  TECHNOLOGY  SUPPLIER"  MEANS  A
COMPANY OR ENTITY THAT:
  (1)  IS  ACCREDITED  BY  A  RECOGNIZED  ACCREDITING  ORGANIZATION AS A
SUPPLIER OF COMPLEX REHABILITATION TECHNOLOGY;
  (2) IS ENROLLED IN THE MEDICARE PROGRAM AND  MEETS  THE  SUPPLIER  AND
QUALITY  STANDARDS  ESTABLISHED  FOR DURABLE MEDICAL EQUIPMENT SUPPLIERS
UNDER THE MEDICARE PROGRAM;
  (3) EMPLOYS AT LEAST ONE  COMPLEX  REHABILITATION  TECHNOLOGY  PROFES-
SIONAL  FOR  EACH  LOCATION  TO  (I) ANALYZE THE NEEDS AND CAPACITIES OF

A. 7527                             3

QUALIFIED INDIVIDUALS WITH COMPLEX MEDICAL NEEDS, (II) ASSIST IN SELECT-
ING APPROPRIATE COVERED COMPLEX REHABILITATION TECHNOLOGY ITEMS FOR SUCH
NEEDS AND CAPACITIES, AND (III) PROVIDE  TRAINING  IN  THE  USE  OF  THE
SELECTED  COVERED  COMPLEX  REHABILITATION TECHNOLOGY ITEMS; THE COMPLEX
REHABILITATION TECHNOLOGY PROFESSIONAL SHALL BE CERTIFIED BY  THE  REHA-
BILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY OF NORTH AMERICA
AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL (ATP);
  (4)  HAS THE COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL PHYSICALLY
PRESENT FOR THE EVALUATION AND DETERMINATION OF THE APPROPRIATE INDIVID-
UALLY CONFIGURED COMPLEX REHABILITATION TECHNOLOGIES FOR  THE  QUALIFIED
INDIVIDUAL WITH COMPLEX MEDICAL NEEDS;
  (5)  PROVIDES  SERVICE  AND  REPAIR  BY  QUALIFIED TECHNICIANS FOR ALL
COMPLEX REHABILITATION TECHNOLOGY PRODUCTS IT SELLS; AND
  (6) PROVIDES WRITTEN INFORMATION TO THE COMPLEX NEEDS PATIENT  AT  THE
TIME  OF  DELIVERY  ABOUT  HOW  THE  INDIVIDUAL  MAY RECEIVE SERVICE AND
REPAIRS.
  (E) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  PROFESSIONAL"  MEANS
AN  INDIVIDUAL  WHO  IS  CERTIFIED BY THE REHABILITATION ENGINEERING AND
ASSISTIVE TECHNOLOGY SOCIETY OF NORTH AMERICA AS AN ASSISTIVE TECHNOLOGY
PROFESSIONAL (ATP).
  2. CREATION OF A SEPARATE RECOGNITION FOR COMPLEX REHABILITATION TECH-
NOLOGY. (A) THE DEPARTMENT OF HEALTH SHALL PROVIDE A  SEPARATE  RECOGNI-
TION  WITHIN  THE  STATE'S  MEDICAID  PROGRAM FOR COMPLEX REHABILITATION
TECHNOLOGY AND SHALL MAKE OTHER REQUIRED CHANGES TO  PROTECT  ACCESS  TO
APPROPRIATE PRODUCTS AND SERVICES. THE DEPARTMENT SHALL PROVIDE SEPARATE
RECOGNITION FOR INDIVIDUALLY CONFIGURED COMPLEX REHABILITATION TECHNOLO-
GY  PRODUCTS  AND  SERVICES  FOR  COMPLEX  NEEDS PATIENTS. SUCH SEPARATE
RECOGNITION SHALL TAKE  INTO  CONSIDERATION  THE  CUSTOMIZED  NATURE  OF
COMPLEX REHABILITATION TECHNOLOGY AND THE BROAD RANGE OF SERVICES NECES-
SARY  TO  MEET  THE  UNIQUE  MEDICAL AND FUNCTIONAL NEEDS OF PEOPLE WITH
COMPLEX MEDICAL NEEDS BY DOING ALL OF THE FOLLOWING:
  (A) BY USING AS A REFERENCE THOSE BILLING CODES LISTED UNDER  SUBPARA-
GRAPHS  ONE AND TWO OF PARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION,
DESIGNATING APPROPRIATE CURRENT BILLING CODES AS COMPLEX  REHABILITATION
TECHNOLOGY  AND,  AS NEEDED, CREATING NEW BILLING CODES FOR SERVICES AND
PRODUCTS COVERED FOR COMPLEX NEEDS PATIENTS.
  (B) ESTABLISHING SPECIFIC SUPPLIER STANDARDS FOR COMPANIES OR ENTITIES
THAT PROVIDE  COMPLEX  REHABILITATION  TECHNOLOGY  AND  RESTRICTING  THE
PROVISION  OF  COMPLEX REHABILITATION TECHNOLOGY TO ONLY THOSE COMPANIES
OR ENTITIES THAT MEET SUCH STANDARDS.
  (C) THE DEPARTMENT SHALL  REQUIRE  COMPLEX  NEEDS  PATIENTS  RECEIVING
COMPLEX REHABILITATION TECHNOLOGY TO BE EVALUATED BY:
  (1)  A  QUALIFIED HEALTH CARE PROFESSIONAL, INCLUDING, BUT NOT LIMITED
TO, A PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST, OR OTHER  HEALTH  CARE
PROFESSIONAL  WHO PERFORMS SPECIALTY EVALUATIONS WITHIN HIS OR HER SCOPE
OF PRACTICE; AND
  (2) A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL.
  S 4. The insurance law is amended by adding a new section 4806 to read
as follows:
  S 4806. COVERAGE FOR COMPLEX REHABILITATION  TECHNOLOGY  PRODUCTS  AND
SERVICES  FOR  COMPLEX  NEEDS  PATIENTS.  ANY MANAGED CARE PLAN AMENDED,
DELIVERED, ISSUED, OR RENEWED IN THIS STATE SHALL ADOPT THE  REGULATIONS
AND POLICIES OUTLINED IN SECTION TWENTY-THREE OF THE PUBLIC HEALTH LAW.
  S 5. This act shall take effect immediately.

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