NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9003
SPONSOR: Steck (MS) TITLE OF BILL:
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
PURPOSE OR GENERAL IDEA OF BILL:
To maintain access to quality complex rehabilitation equipment for
patients with specific diagnoses and physical conditions who require
individually configured equipment and technology to sustain independence
and avoid institutionalization. The bill will also safeguard the config-
uration, delivery and repair of customized technology and equipment by
establishing qualifications currently sought administratively through
prior authorization and administrative review.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends the social service law by adding a new section, 367-j.
Subdivision 1 defines complex needs patients and complex rehabilitation
technology, as well as the required qualifications of individuals and
entities eligible to configure and supply such equipment.
Subdivision 2 directs the commissioner to monitor the addition of new
billing codes for complex rehabilitation technology by the Medicare
program and to expeditiously add these codes to the Medicaid program.
Section 2 provides the effective date.
JUSTIFICATION:
A small portion of the population depends on medically necessary, indi-
vidually configured equipment, known as complex rehabilitation technolo-
gy (CRT), to maintain their mobility, quality of life, and independence.
CRT includes individually configured manual and power wheelchairs, adap-
tive seating and position items, and other equipment designed to meet a
patient's unique needs. For individuals with significant physical or
functional impairments, having the appropriate equipment can mean the
difference between constant pain and immobility and an active, fulfill-
ing life.
The existing process to qualify for and configure CRT for Medicaid bene-
ficiaries, which this bill codifies, ensures that appropriately diag-
nosed patients are able to access CRT, and that CRT suppliers meet
stringent requirements to protect quality and access to service and
repairs.
Since CRT is a rapidly developing industry, the new technology often
does not fit into existing durable medical equipment (DME) billing cate-
gories. For example, a powered wheelchair with a custom-molded seat that
supports the unique shape and pressure points of an individual with
severe spinal curvature is not interchangeable with an off-the-shelf
model that will cause sores, pain, and immobility. Thus, a crucial part
of protecting access to this highly specialized equipment is keeping the
billing codes used by Medicaid updated with the new codes added for CRT
to the Medicare billing system. The timely addition of new billing codes
that conform to Medicare changes will remove a hurdle many Medicaid
beneficiaries face when trying to access the equipment they need.
PRIOR LEGISLATIVE HISTORY:
2017/18: A10604 passed Assembly
Same as A.6120-B of 2018; Veto 165
Similar to A. 5074-C of 2016; Veto 270
2019: A7492/55741 passed both Assembly and Senate; Veto 142
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
The first of April next succeeding the date on which it shall have
become law; provided that effective immediately, the commissioner of
health shall make regulations and take other actions reasonably neces-
sary to implement this act on that date.
STATE OF NEW YORK
________________________________________________________________________
9003
IN ASSEMBLY
January 10, 2020
___________
Introduced by M. of A. STECK, D'URSO, DICKENS, SAYEGH, ENGLEBRIGHT,
McDONALD, CRUZ, COLTON, BUTTENSCHON, SIMON, JAFFEE, GOTTFRIED,
EPSTEIN, SANTABARBARA, SALKA, WEPRIN, L. ROSENTHAL, SEAWRIGHT, REYES,
LAWRENCE, WILLIAMS, M. L. MILLER, NIOU -- read once and referred 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:
1 Section 1. The social services law is amended by adding a new section
2 367-j to read as follows:
3 § 367-j. Complex rehabilitation technology; coverage and safeguards.
4 1. Definitions. As used in this section:
5 (a) "Complex needs patient" means a medical assistance enrollee with
6 significant physical or functional impairment resulting from a medical
7 condition or disease including, but not limited to: spinal cord injury,
8 traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifi-
9 da, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclero-
10 sis, multiple sclerosis, demyelinating disease, myelopathy, myopathy,
11 progressive muscular atrophy, anterior horn cell disease, post-polio
12 syndrome, cerebellar degeneration, dystonia, huntington's disease,
13 spinocerebellar disease, and certain types of amputation, paralysis or
14 paresis.
15 (b) "Complex rehabilitation technology" means products classified as
16 durable medical equipment within the medicare program that are individ-
17 ually configured for individuals to meet their specific and unique
18 medical, physical and functional needs and capacities for basic and
19 functional activities of daily living. Such products include, but are
20 not limited to: individually configured manual and power wheelchairs
21 and accessories, adaptive seating and positioning items and accessories,
22 and other specialized equipment such as standing frames and gait train-
23 ers and accessories.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11457-02-9
A. 9003 2
1 (c) "Individually configured" means a device with a combination of
2 sizes, features, adjustments or modifications that are configured or
3 designed by a qualified complex rehabilitation technology supplier for a
4 specific individual by measuring, fitting, programming, adjusting or
5 adapting the device so that the device is consistent with the individ-
6 ual's medical condition, physical and functional needs and capabilities,
7 body size, period of need and intended use as determined by an assess-
8 ment or evaluation by a qualified health care professional.
9 (d) "Qualified complex rehabilitation technology professional" means
10 an individual who is certified as an assistive technology professional
11 by a nationally-recognized rehabilitation engineering and assistive
12 technology society.
13 (e) "Qualified complex rehabilitation technology supplier" means a
14 company or entity that:
15 (i) is accredited by a nationally-recognized accrediting organization;
16 (ii) is an enrolled supplier for durable medical equipment under the
17 federal medicare program and the medical assistance program under this
18 title;
19 (iii) has at least one qualified complex rehabilitation technology
20 professional available to analyze the needs and capacities of complex
21 needs patients in consultation with a qualified health care professional
22 and participate in the selection of appropriate complex rehabilitation
23 technology and provide training in the proper use of the complex reha-
24 bilitation technology;
25 (iv) requires a qualified complex rehabilitation technology profes-
26 sional be physically present for the evaluation and determination of
27 appropriate complex rehabilitation technology for complex needs
28 patients;
29 (v) has the capability to provide service and repair by qualified
30 technicians for all complex rehabilitation technology it sells;
31 (vi) has at least one retail vending location within New York state;
32 and
33 (vii) provides written information regarding how to receive service
34 and repair of complex rehabilitation technology to the complex needs
35 patient prior to the ordering of such technology.
36 (f) "Qualified health care professional" means a health care profes-
37 sional licensed or otherwise authorized to practice under title eight of
38 the education law, acting within his or her scope of practice who has no
39 financial relationship with the complex rehabilitation technology
40 supplier.
41 2. Reimbursement and billing procedures. (a) The commissioner shall
42 maintain specific reimbursement and billing procedures under this title
43 for complex rehabilitation technology products to ensure that Medicaid
44 payments for such products permit adequate access to such products and
45 services for complex needs patients and take into account the signif-
46 icant resources, infrastructure, and staff needed.
47 (b) The commissioner shall monitor the addition of new billing codes
48 for complex rehabilitation technology by the medicare program and shall
49 expeditiously incorporate such codes under this subdivision.
50 (c) Where reimbursement rates for complex rehabilitation technology
51 products provided under section forty-four hundred three-f of the public
52 health law or section three hundred sixty-four-j of this title are
53 determined by a managed care organization, they shall be determined
54 consistent with this subdivision. The commissioner may establish minimum
55 benchmark reimbursement rates to be paid by managed care organizations
56 under this paragraph.
A. 9003 3
1 § 2. This act shall take effect on the first of April next succeeding
2 the date on which it shall have become a law.
