S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6120
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 23, 2017
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend  the  social  services law, in relation to preserving
   access to quality 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. Short title. This act shall be known and may  be  cited  as
 the "complex needs patient act".
   § 2. Legislative intent. It is the intent of the legislature to:
   1.  protect access for complex needs patients to quality complex reha-
 bilitation technology;
   2. establish and improve standards  and  safeguards  relating  to  the
 provision of complex rehabilitation technology; and
   3.  provide  quality support for complex needs patients to stay in the
 home or community setting,  prevent  institutionalization,  and  prevent
 hospitalizations and other costly secondary complications.
   §  3. The social services law is amended by adding a new section 367-j
 to read as follows:
   § 367-J. COMPLEX NEEDS PATIENT ACT.  1. DEFINITIONS. AS USED  IN  THIS
 SECTION:
   (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH SIGNIFICANT PHYS-
 ICAL  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 BIFIDA, OSTEO-
 GENESIS  IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC  LATERAL   SCLEROSIS,
 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04523-02-7

 A. 6120                             2
 
   (B)  "COMPLEX  REHABILITATION TECHNOLOGY" MEANS PRODUCTS CLASSIFIED AS
 DURABLE MEDICAL EQUIPMENT WITHIN THE  MEDICARE  PROGRAM  AS  OF  JANUARY
 FIRST,  TWO  THOUSAND FIFTEEN THAT ARE INDIVIDUALLY CONFIGURED FOR INDI-
 VIDUALS TO MEET THEIR SPECIFIC AND UNIQUE MEDICAL,  PHYSICAL  AND  FUNC-
 TIONAL 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  SEAT-
 ING  AND POSITIONING ITEMS AND ACCESSORIES, AND OTHER SPECIALIZED EQUIP-
 MENT SUCH AS STANDING FRAMES AND GAIT TRAINERS AND ACCESSORIES.
   (C) "EMPLOYEE" MEANS A PERSON WHOSE TAXES ARE WITHHELD BY A  QUALIFIED
 COMPLEX  REHABILITATION TECHNOLOGY SUPPLIER AND REPORTED TO THE INTERNAL
 REVENUE SERVICE.
   (D) "HEALTHCARE COMMON PROCEDURE CODING SYSTEM", OR "HCPCS", MEANS THE
 BILLING CODES USED BY MEDICARE AND OVERSEEN BY THE FEDERAL  CENTERS  FOR
 MEDICARE  AND MEDICAID SERVICES THAT ARE BASED ON THE CURRENT PROCEDURAL
 TECHNOLOGY CODES DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION.
   (E) "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
 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.
   (F)  "MIXED  HCPCS  CODES"  MEANS  HEALTHCARE  COMMON PROCEDURE CODING
 SYSTEM CODES THAT REFER TO A MIX OF  COMPLEX  REHABILITATION  TECHNOLOGY
 PRODUCTS AND STANDARD MOBILITY AND ACCESSORY PRODUCTS.
   (G) "PURE HCPCS CODES" MEANS HEALTHCARE COMMON PROCEDURE CODING SYSTEM
 CODES  THAT  REFER  EXCLUSIVELY  TO  COMPLEX  REHABILITATION  TECHNOLOGY
 PRODUCTS.
   (H) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  PROFESSIONAL"  MEANS
 AN  INDIVIDUAL  WHO IS CERTIFIED AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL
 (ATP) BY THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY
 OF NORTH AMERICA (RESNA).
   (I) "QUALIFIED COMPLEX REHABILITATION  TECHNOLOGY  SUPPLIER"  MEANS  A
 COMPANY OR ENTITY THAT:
   (I) IS ACCREDITED BY A RECOGNIZED ACCREDITING ORGANIZATION;
   (II) IS AN ENROLLED MEDICARE SUPPLIER AND MEETS THE SUPPLIER AND QUAL-
 ITY  STANDARDS  ESTABLISHED  FOR  DURABLE  MEDICAL  EQUIPMENT  SUPPLIERS
 INCLUDING THOSE FOR COMPLEX REHABILITATION TECHNOLOGY UNDER THE MEDICARE
 PROGRAM;
   (III) HAS AT LEAST ONE EMPLOYEE WHO IS A QUALIFIED  COMPLEX  REHABILI-
 TATION TECHNOLOGY PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPAC-
 ITIES  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 REHABILITATION 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 STOREFRONT LOCATION WITHIN NEW YORK STATE; AND

 A. 6120                             3
 
   (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.
   (J)  "QUALIFIED  HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROFES-
 SIONAL LICENSED BY THE STATE EDUCATION DEPARTMENT WHO HAS  NO  FINANCIAL
 RELATIONSHIP  WITH A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLI-
 ER, INCLUDING BUT NOT LIMITED TO A PHYSICIAN, PHYSICAL THERAPIST,  OCCU-
 PATIONAL  THERAPIST,  OR  OTHER  LICENSED  HEALTH  CARE PROFESSIONAL WHO
 PERFORMS SPECIALTY EVALUATIONS WITHIN THE PROFESSIONAL'S SCOPE OF  PRAC-
 TICE.
   2. REIMBURSEMENT AND BILLING PROCEDURES. (A) TO THE EXTENT PERMISSIBLE
 UNDER  FEDERAL  LAW, THE COMMISSIONER SHALL MAINTAIN SPECIFIC REIMBURSE-
 MENT AND BILLING  PROCEDURES  WITHIN  THE  STATE  MEDICAID  PROGRAM  FOR
 COMPLEX  REHABILITATION  TECHNOLOGY PRODUCTS AND SERVICES TO ENSURE THAT
 MEDICAID PAYMENTS FOR SUCH PRODUCTS AND SERVICES PERMIT ADEQUATE  ACCESS
 TO  COMPLEX  NEEDS  PATIENTS  AND  TAKES  INTO  ACCOUNT  THE SIGNIFICANT
 RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED TO MEET THEIR NEEDS.
   (B) PURSUANT TO PARAGRAPH (A) OF THIS  SUBDIVISION,  THE  COMMISSIONER
 SHALL,  NOT  LATER THAN OCTOBER FIRST, TWO THOUSAND NINETEEN: (I) DESIG-
 NATE PRODUCTS AND SERVICES INCLUDED IN  MIXED  AND  PURE  HCPCS  BILLING
 CODES  AS COMPLEX REHABILITATION TECHNOLOGY, AND AS DEEMED NECESSARY AND
 APPROPRIATE BY THE COMMISSIONER, CREATE NEW BILLING CODES OR CODE  MODI-
 FIERS 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  MEDICAID
 REIMBURSEMENT; (III) EXEMPT PRODUCTS OR SERVICES BILLED UNDER  MIXED  OR
 PURE  HCPCS  CODES FROM INCLUSION IN ANY BIDDING, SELECTIVE CONTRACTING,
 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 TECHNOLOGY
 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. THE REIMBURSEMENT RATE  PAID  TO  PROVIDERS  FOR
 COMPLEX  REHABILITATION TECHNOLOGY 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 AGREEMENT 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 ORGANIZATION'S PREMIUMS AND THE  COMMISSIONER  SHALL
 PROVIDE  FOR  THE  EXPEDITIOUS  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  BENCH-
 MARK  RATE  IS  SPECIFICALLY IDENTIFIED AND INCLUDED IN THE MANAGED CARE
 ORGANIZATIONS PREMIUMS.
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the  date  on  which it shall have become a law, and shall apply to
 contracts and policies issued, renewed, modified or amended on or  after
 such effective date.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6120--B
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 23, 2017
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Health -- committee discharged, bill amended, ordered reprinted
   as  amended and recommitted to said committee -- reported and referred
   to the Committee on Ways  and  Means  --  committee  discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee
 
 AN ACT to amend  the  social  services  law,  in  relation  to  Medicaid
   reimbursement  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; REIMBURSEMENT. 1.    DEFI-
 NITIONS. 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04523-05-7

 A. 6120--B                          2
 
 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
 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.
   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

 A. 6120--B                          3
 
 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.