S T A T E   O F   N E W   Y O R K
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                                   5741
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               May 14, 2019
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed 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
 SPECIFIC INDIVIDUAL BY MEASURING,  FITTING,  PROGRAMMING,  ADJUSTING  OR
              

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11457-02-9

 S. 5741                             2
 
 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.