S T A T E O F N E W Y O R K
________________________________________________________________________
8142
I N S E N A T E
June 14, 2016
___________
Introduced by Sen. ORTT -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
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
S. 8142 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.
