S03651 Summary:
BILL NO | S03651D |
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SAME AS | SAME AS A05074-C |
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SPONSOR | ORTT |
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COSPNSR | AVELLA, ROBACH |
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MLTSPNSR | |
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Add §367-j, Soc Serv L; amd §4403, Pub Health L | |
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Establishes the "complex needs patient act" including definitions and reimbursement and billing procedures; preserves access to quality complex rehabilitation technology for patients with complex medical needs. |
S03651 Actions:
BILL NO | S03651D | |||||||||||||||||||||||||||||||||||||||||||||||||
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02/13/2015 | REFERRED TO HEALTH | |||||||||||||||||||||||||||||||||||||||||||||||||
02/23/2015 | AMEND AND RECOMMIT TO HEALTH | |||||||||||||||||||||||||||||||||||||||||||||||||
02/23/2015 | PRINT NUMBER 3651A | |||||||||||||||||||||||||||||||||||||||||||||||||
04/30/2015 | AMEND AND RECOMMIT TO HEALTH | |||||||||||||||||||||||||||||||||||||||||||||||||
04/30/2015 | PRINT NUMBER 3651B | |||||||||||||||||||||||||||||||||||||||||||||||||
05/08/2015 | COMMITTEE DISCHARGED AND COMMITTED TO INSURANCE | |||||||||||||||||||||||||||||||||||||||||||||||||
05/28/2015 | AMEND (T) AND RECOMMIT TO INSURANCE | |||||||||||||||||||||||||||||||||||||||||||||||||
05/28/2015 | PRINT NUMBER 3651C | |||||||||||||||||||||||||||||||||||||||||||||||||
01/06/2016 | REFERRED TO INSURANCE | |||||||||||||||||||||||||||||||||||||||||||||||||
01/15/2016 | AMEND AND RECOMMIT TO INSURANCE | |||||||||||||||||||||||||||||||||||||||||||||||||
01/15/2016 | PRINT NUMBER 3651D | |||||||||||||||||||||||||||||||||||||||||||||||||
06/06/2016 | COMMITTEE DISCHARGED AND COMMITTED TO RULES | |||||||||||||||||||||||||||||||||||||||||||||||||
06/06/2016 | ORDERED TO THIRD READING CAL.1434 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/08/2016 | PASSED SENATE | |||||||||||||||||||||||||||||||||||||||||||||||||
06/08/2016 | DELIVERED TO ASSEMBLY | |||||||||||||||||||||||||||||||||||||||||||||||||
06/08/2016 | referred to ways and means | |||||||||||||||||||||||||||||||||||||||||||||||||
06/14/2016 | substituted for a5074c | |||||||||||||||||||||||||||||||||||||||||||||||||
06/14/2016 | ordered to third reading rules cal.271 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/14/2016 | passed assembly | |||||||||||||||||||||||||||||||||||||||||||||||||
06/14/2016 | returned to senate | |||||||||||||||||||||||||||||||||||||||||||||||||
11/16/2016 | DELIVERED TO GOVERNOR | |||||||||||||||||||||||||||||||||||||||||||||||||
11/28/2016 | VETOED MEMO.270 |
S03651 Committee Votes:
Go to topS03651 Floor Votes:
Yes
Abbate
Yes
Crespo
Yes
Gottfried
Yes
Lopez
Yes
Palumbo
ER
Simon
Yes
Abinanti
Yes
Crouch
Yes
Graf
Yes
Lupardo
Yes
Paulin
Yes
Simotas
Yes
Arroyo
Yes
Curran
Yes
Gunther
Yes
Lupinacci
Yes
Peoples-Stokes
Yes
Skartados
Yes
Aubry
Yes
Cusick
Yes
Harris
Yes
Magee
Yes
Perry
Yes
Skoufis
Yes
Barclay
Yes
Cymbrowitz
Yes
Hawley
Yes
Magnarelli
Yes
Pichardo
Yes
Solages
Yes
Barrett
Yes
Davila
Yes
Hevesi
Yes
Malliotakis
Yes
Pretlow
Yes
Stec
Yes
Barron
Yes
DenDekker
Yes
Hikind
Yes
Markey
Yes
Quart
Yes
Steck
Yes
Benedetto
Yes
Dilan
Yes
Hooper
Yes
Mayer
Yes
Ra
Yes
Stirpe
Yes
Bichotte
Yes
Dinowitz
Yes
Hunter
Yes
McDonald
Yes
Raia
Yes
Tedisco
Yes
Blake
ER
DiPietro
Yes
Hyndman
Yes
McDonough
Yes
Ramos
Yes
Tenney
Yes
Blankenbush
Yes
Duprey
Yes
Jaffee
Yes
McKevitt
Yes
Richardson
Yes
Thiele
Yes
Brabenec
Yes
Englebright
Yes
Jean-Pierre
Yes
McLaughlin
Yes
Rivera
Yes
Titone
Yes
Braunstein
Yes
Fahy
Yes
Johns
Yes
Miller
Yes
Robinson
Yes
Titus
ER
Brennan
Yes
Farrell
Yes
Joyner
Yes
Montesano
Yes
Rodriguez
Yes
Walker
Yes
Brindisi
ER
Finch
Yes
Katz
Yes
Morelle
Yes
Rosenthal
Yes
Walter
Yes
Bronson
Yes
Fitzpatrick
Yes
Kavanagh
Yes
Mosley
Yes
Rozic
Yes
Weinstein
Yes
Buchwald
Yes
Friend
Yes
Kearns
Yes
Moya
Yes
Russell
Yes
Weprin
Yes
Butler
Yes
Galef
Yes
Kim
Yes
Murray
Yes
Ryan
Yes
Williams
Yes
Cahill
Yes
Gantt
Yes
Kolb
Yes
Nojay
Yes
Saladino
Yes
Woerner
Yes
Cancel
Yes
Garbarino
Yes
Lalor
Yes
Nolan
Yes
Santabarbara
Yes
Wozniak
Yes
Castorina
Yes
Giglio
Yes
Lavine
Yes
Oaks
Yes
Schimel
ER
Wright
Yes
Ceretto
Yes
Gjonaj
Yes
Lawrence
Yes
O'Donnell
Yes
Schimminger
Yes
Zebrowski
Yes
Colton
Yes
Glick
Yes
Lentol
Yes
Ortiz
Yes
Seawright
Yes
Mr. Speaker
Yes
Cook
Yes
Goldfeder
Yes
Lifton
Yes
Otis
Yes
Sepulveda
Yes
Corwin
Yes
Goodell
Yes
Linares
Yes
Palmesano
ER
Simanowitz
‡ Indicates voting via videoconference
S03651 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 3651--D 2015-2016 Regular Sessions IN SENATE February 13, 2015 ___________ Introduced by Sen. ORTT -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged and said bill committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the social services law and the public health law, in relation to preserving access to quality complex rehabilitation tech- nology 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. Short title. This act shall be known and may be cited as 2 the "complex needs patient act". 3 § 2. Legislative intent. It is the intent of the legislature to: 4 1. protect access for complex needs patients to quality complex reha- 5 bilitation technology; 6 2. establish and improve standards and safeguards relating to the 7 provision of complex rehabilitation technology; and 8 3. provide quality support for complex needs patients to stay in the 9 home or community setting, prevent institutionalization, and prevent 10 hospitalizations and other costly secondary complications. 11 § 3. The social services law is amended by adding a new section 367-j 12 to read as follows: 13 § 367-j. Complex needs patient act. 1. Definitions. As used in this 14 section: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07851-06-6S. 3651--D 2 1 (a) "Complex needs patient" means an individual with significant phys- 2 ical or functional impairment resulting from a medical condition or 3 disease including, but not limited to: spinal cord injury, traumatic 4 brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteo- 5 genesis imperfecta, arthrogryposis, amyotrophic lateral sclerosis, 6 multiple sclerosis, demyelinating disease, myelopathy, myopathy, 7 progressive muscular atrophy, anterior horn cell disease, post-polio 8 syndrome, cerebellar degeneration, dystonia, huntington's disease, 9 spinocerebellar disease, and certain types of amputation, paralysis or 10 paresis. 11 (b) "Complex rehabilitation technology" means products classified as 12 durable medical equipment within the medicare program as of January 13 first, two thousand fifteen that are individually configured for indi- 14 viduals to meet their specific and unique medical, physical and func- 15 tional needs and capacities for basic and functional activities of daily 16 living. Such products include, but are not limited to: individually 17 configured manual and power wheelchairs and accessories, adaptive seat- 18 ing and positioning items and accessories, and other specialized equip- 19 ment such as standing frames and gait trainers and accessories. 20 (c) "Employee" means a person whose taxes are withheld by a qualified 21 complex rehabilitation technology supplier and reported to the internal 22 revenue service. 23 (d) "Healthcare common procedure coding system", or "HCPCS", means the 24 billing codes used by medicare and overseen by the federal centers for 25 medicare and medicaid services that are based on the current procedural 26 technology codes developed by the American medical association. 27 (e) "Individually configured" means a device with a combination of 28 sizes, features, adjustments or modifications that are configured or 29 designed by a qualified complex rehabilitation technology supplier for a 30 specific individual by measuring, fitting, programming, adjusting or 31 adapting the device so that the device is consistent with the individ- 32 ual's medical condition, physical and functional needs and capabilities, 33 body size, period of need and intended use as determined by an assess- 34 ment or evaluation by a qualified health care professional. 35 (f) "Mixed HCPCS codes" means Healthcare Common Procedure Coding 36 System codes that refer to a mix of complex rehabilitation technology 37 products and standard mobility and accessory products. 38 (g) "Pure HCPCS codes" means Healthcare Common Procedure Coding System 39 codes that refer exclusively to complex rehabilitation technology 40 products. 41 (h) "Qualified complex rehabilitation technology professional" means 42 an individual who is certified as an assistive technology professional 43 (ATP) by the Rehabilitation Engineering and Assistive Technology Society 44 of North America (RESNA). 45 (i) "Qualified complex rehabilitation technology supplier" means a 46 company or entity that: 47 (i) is accredited by a recognized accrediting organization; 48 (ii) is an enrolled medicare supplier and meets the supplier and qual- 49 ity standards established for durable medical equipment suppliers 50 including those for complex rehabilitation technology under the medicare 51 program; 52 (iii) has at least one employee who is a qualified complex rehabili- 53 tation technology professional available to analyze the needs and capac- 54 ities of complex needs patients in consultation with a qualified health 55 care professional and participate in the selection of appropriateS. 3651--D 3 1 complex rehabilitation technology and provide training in the proper use 2 of the complex rehabilitation technology; 3 (iv) requires a qualified complex rehabilitation technology profes- 4 sional be physically present for the evaluation and determination of 5 appropriate complex rehabilitation technology for complex needs 6 patients; 7 (v) has the capability to provide service and repair by qualified 8 technicians for all complex rehabilitation technology it sells; 9 (vi) has at least one storefront location within New York state; and 10 (vii) provides written information regarding how to receive service 11 and repair of complex rehabilitation technology to the complex needs 12 patient prior to the ordering of such technology. 13 (j) "Qualified health care professional" means a health care profes- 14 sional licensed by the state education department who has no financial 15 relationship with a qualified complex rehabilitation technology suppli- 16 er, including but not limited to a physician, physical therapist, occu- 17 pational therapist, or other licensed health care professional who 18 performs specialty evaluations within the professional's scope of prac- 19 tice. 20 2. Reimbursement and billing procedures. (a) To the extent permissible 21 under federal law, the commissioner shall maintain specific reimburse- 22 ment and billing procedures within the state medicaid program for 23 complex rehabilitation technology products and services to ensure that 24 medicaid payments for such products and services permit adequate access 25 to complex needs patients and takes into account the significant 26 resources, infrastructure, and staff needed to meet their needs. 27 (b) Pursuant to paragraph (a) of this subdivision, the commissioner 28 shall, not later than October first, two thousand eighteen: (i) desig- 29 nate products and services included in mixed and pure HCPCS billing 30 codes as complex rehabilitation technology, and as needed, create new 31 billing codes or code modifiers for services and products covered for 32 complex needs patients; (ii) set minimum standards consistent with para- 33 graph (i) of subdivision one of this section in order for suppliers to 34 be considered qualified complex rehabilitation technology suppliers 35 eligible for medicaid reimbursement; (iii) exempt products or services 36 billed under mixed or pure HCPCS codes from inclusion in any bidding, 37 selective contracting, request for proposal, or similar initiative; (iv) 38 require complex needs patients receiving a complex rehabilitation manual 39 wheelchair, power wheelchair, or seating component to be evaluated by a 40 qualified health care professional and a qualified complex rehabili- 41 tation technology professional to qualify for reimbursement (such evalu- 42 ation shall be exempt from any health care professional cap); (v) make 43 other changes as needed to protect access to complex rehabilitation 44 technology for complex needs patients; and (vi) affirm that with the 45 exception of those enrollees covered under a payment rate methodology 46 otherwise negotiated, payments for complex rehabilitation technology 47 provided to patients eligible for medical assistance by organizations 48 operating in accordance with the provisions of article forty-four of the 49 public health law or by health maintenance organizations organized and 50 operating in accordance with article forty-three of the insurance law, 51 shall be the rates of payment that would be paid for such payments under 52 the medical assistance program as determined by the commissioner and 53 applicable to services at the time such services were provided. 54 § 4. Section 4403 of the public health law is amended by adding a new 55 subdivision 9 to read as follows:S. 3651--D 4 1 9. Every health maintenance organization shall include adequate access 2 to services and equipment provided by qualified complex rehabilitation 3 technology suppliers, pursuant to section three hundred sixty-seven-j of 4 the social services law, and adopt the supplier standards contained 5 therein. 6 § 5. This act shall take effect on the first of January next succeed- 7 ing the date on which it shall have become a law, and shall apply to 8 contracts and policies issued, renewed, modified or amended on or after 9 such effective date.