NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A646
SPONSOR: Steck 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:
2020/22: A3132 referred to health; reported referred
2019/20: A7492 passed Assembly and Senate; Veto142
2017/18: A10604 passed Assembly
Same as A.6120-8 of 2018; Veto 165
Similar to A. 5074-C of 2016; Veto 270 to ways and means
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.
