Assembly Bill A10718

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  10718

                          I N  A S S E M B L Y

                              June 13, 2016
                               ___________

Introduced by COMMITTEE ON RULES -- (at request of M. of A. McDonald) --
  read once and referred to the Committee on Health

AN ACT to amend the social services law, in relation to complex rehabil-
  itation  technology  products  and services; and to repeal subdivision
  nine of section 4403 of the public health law relating thereto

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

  Section  1.  Paragraph  (b)  of  subdivision 2 of section 367-j of the
social services law, as added by a chapter of the laws of 2016  amending
the social services law and the public health law relating to preserving
access  to  quality  complex rehabilitation technology for patients with
complex medical needs, as proposed in legislative bills numbers S.3651-D
and A. 5074-C, is amended to read as follows:
  (b) Pursuant to paragraph (a) of this  subdivision,  the  commissioner
shall,  not  later than October first, two thousand eighteen: (i) desig-
nate products and services included in  mixed  and  pure  HCPCS  billing
codes  as  complex  rehabilitation  technology,  and  as [needed] DEEMED
NECESSARY AND APPROPRIATE BY THE COMMISSIONER, create new billing  codes
or  code  modifiers  for services and products covered for complex needs
patients; (ii) set minimum standards consistent with  paragraph  (i)  of
subdivision  one of this section in order for suppliers to be considered
qualified complex rehabilitation technology suppliers eligible for medi-
caid reimbursement; (iii) exempt products or services billed under mixed
or pure HCPCS codes from inclusion in any bidding,  selective  contract-
ing,  request  for proposal, or similar initiative; (iv) require complex
needs patients receiving a  complex  rehabilitation  manual  wheelchair,
power  wheelchair,  or  seating component to be evaluated by a qualified
health care professional and a qualified complex rehabilitation technol-
ogy professional to qualify for reimbursement (such evaluation shall  be
exempt from any health care professional cap); AND (v) make other chang-
es  as needed to protect access to complex rehabilitation technology for
complex needs patients[; and (vi) affirm  that  with  the  exception  of
those enrollees covered under a payment rate methodology otherwise nego-
tiated,  payments  for  complex  rehabilitation  technology  provided to

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

                                                           LBD15880-01-6

A. 10718                            2

patients eligible for medical assistance by organizations  operating  in
accordance  with  the  provisions  of  article  forty-four of the public
health law or by health maintenance organizations organized and  operat-
ing  in  accordance with article forty-three of the insurance law, shall
be the rates of payment that would be paid for such payments  under  the
medical  assistance program as determined by the commissioner and appli-
cable to services  at  the  time  such  services  were  provided.].  THE
REIMBURSEMENT RATE PAID TO PROVIDERS FOR COMPLEX REHABILITATION TECHNOL-
OGY  PRODUCTS  AND  SERVICES  BY  MANAGED CARE ORGANIZATIONS PURSUANT TO
SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW AND  SECTION
THREE  HUNDRED  SIXTY-FOUR-J OF THIS TITLE SHALL BE DETERMINED BY AGREE-
MENT BETWEEN THE PROVIDER AND MANAGED CARE ORGANIZATION. THE  AMOUNT  OF
ANY  REIMBURSEMENT  RATE  INCREASE  RESULTING FROM THE IMPLEMENTATION OF
THIS SECTION SHALL BE SPECIFICALLY IDENTIFIED IN THE MANAGED CARE ORGAN-
IZATION'S PREMIUMS AND THE COMMISSIONER  SHALL  PROVIDE  FOR  THE  EXPE-
DITIOUS  INCREASE OF SUCH PREMIUMS TO ENSURE THE ACTUARIAL SOUNDNESS AND
ADEQUACY OF SUCH PREMIUMS AND TO ACCURATELY ACCOUNT FOR THE COST OF  THE
AMOUNTS  PAID  TO PROVIDERS PURSUANT TO THIS SECTION.  THE COMMISSIONER,
IN HIS OR HER JUDGMENT, MAY ESTABLISH A MINIMUM BENCHMARK  REIMBURSEMENT
RATE FOR MANAGED CARE ORGANIZATIONS TO PAY CONTRACTED PROVIDERS PURSUANT
TO THIS SECTION, PROVIDED SUCH BENCHMARK RATE IS SPECIFICALLY IDENTIFIED
AND INCLUDED IN THE MANAGED CARE ORGANIZATIONS PREMIUMS.
  S  2.  Subdivision  9  of  section  4403  of  the public health law is
repealed.
  S 3. This act shall take effect on the  same  date  and  in  the  same
manner as a chapter of the laws of 2016 amending the social services law
and  the  public  health  law  relating  to preserving access to quality
complex rehabilitation technology  for  patients  with  complex  medical
needs,  as  proposed in legislative bills numbers S.3651-D and A. 5074-C
takes effect.