STATE OF NEW YORK
________________________________________________________________________
4232
2023-2024 Regular Sessions
IN ASSEMBLY
February 13, 2023
___________
Introduced by M. of A. STECK, BUTTENSCHON, COLTON, CRUZ, DICKENS,
EPSTEIN, REYES, L. ROSENTHAL, SANTABARBARA, SAYEGH, SEAWRIGHT, SIMON,
WEPRIN, WILLIAMS -- 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.
24 (c) "Individually configured" means a device with a combination of
25 sizes, features, adjustments or modifications that are configured or
26 designed by a qualified complex rehabilitation technology supplier for a
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05515-01-3
A. 4232 2
1 specific individual by measuring, fitting, programming, adjusting or
2 adapting the device so that the device is consistent with the individ-
3 ual's medical condition, physical and functional needs and capabilities,
4 body size, period of need and intended use as determined by an assess-
5 ment or evaluation by a qualified health care professional.
6 (d) "Qualified complex rehabilitation technology professional" means
7 an individual who is certified as an assistive technology professional
8 by a nationally-recognized rehabilitation engineering and assistive
9 technology society.
10 (e) "Qualified complex rehabilitation technology supplier" means a
11 company or entity that:
12 (i) is accredited by a nationally-recognized accrediting organization;
13 (ii) is an enrolled supplier for durable medical equipment under the
14 federal medicare program and the medical assistance program under this
15 title;
16 (iii) has at least one qualified complex rehabilitation technology
17 professional available to analyze the needs and capacities of complex
18 needs patients in consultation with a qualified health care professional
19 and participate in the selection of appropriate complex rehabilitation
20 technology and provide training in the proper use of the complex reha-
21 bilitation technology;
22 (iv) requires a qualified complex rehabilitation technology profes-
23 sional be physically present for the evaluation and determination of
24 appropriate complex rehabilitation technology for complex needs
25 patients;
26 (v) has the capability to provide service and repair by qualified
27 technicians for all complex rehabilitation technology it sells;
28 (vi) has at least one retail vending location within New York state;
29 and
30 (vii) provides written information regarding how to receive service
31 and repair of complex rehabilitation technology to the complex needs
32 patient prior to the ordering of such technology.
33 (f) "Qualified health care professional" means a health care profes-
34 sional licensed or otherwise authorized to practice under title eight of
35 the education law, acting within his or her scope of practice who has no
36 financial relationship with the complex rehabilitation technology
37 supplier.
38 2. Reimbursement and billing procedures. (a) The commissioner shall
39 maintain specific reimbursement and billing procedures under this title
40 for complex rehabilitation technology products to ensure that Medicaid
41 payments for such products permit adequate access to such products and
42 services for complex needs patients and take into account the signif-
43 icant resources, infrastructure, and staff needed.
44 (b) The commissioner shall monitor the addition of new billing codes
45 for complex rehabilitation technology by the medicare program and shall
46 expeditiously incorporate such codes under this subdivision.
47 (c) Where reimbursement rates for complex rehabilitation technology
48 products provided under section forty-four hundred three-f of the public
49 health law or section three hundred sixty-four-j of this title are
50 determined by a managed care organization, they shall be determined
51 consistent with this subdivision. The commissioner may establish minimum
52 benchmark reimbursement rates to be paid by managed care organizations
53 under this paragraph.
54 § 2. This act shall take effect on the first of April next succeeding
55 the date on which it shall have become a law.
