S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5074

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 12, 2015
                               ___________

Introduced  by  M.  of  A. McDONALD, LAVINE, MONTESANO, MILLER, GUNTHER,
  LIFTON -- Multi-Sponsored by -- M. of A. DUPREY, HOOPER, SIMANOWITZ --
  read once and referred to the Committee on Health

AN ACT to amend the social services  law,  the  insurance  law  and  the
  public health law, in relation to preserving access to quality 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. Short title. This act shall be known and may  be  cited  as
the "complex needs patient act".
  S 2. Legislative intent. It is the intent of the legislature to:
  1.  protect access for complex needs patients to quality complex reha-
bilitation technology;
  2. establish and improve standards  and  safeguards  relating  to  the
provision of complex rehabilitation technology; and
  3.  provide  quality support for complex needs patients to stay in the
home or community setting,  prevent  institutionalization,  and  prevent
hospitalizations and other costly secondary complications.
  S  3. The social services law is amended by adding a new section 367-j
to read as follows:
  S 367-J. COMPLEX NEEDS PATIENT ACT.  1. DEFINITIONS. AS USED  IN  THIS
SECTION:
  (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH SIGNIFICANT PHYS-
ICAL  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 BIFIDA, OSTEO-
GENESIS  IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC  LATERAL   SCLEROSIS,
MULTIPLE   SCLEROSIS,   DEMYELINATING   DISEASE,  MYELOPATHY,  MYOPATHY,
PROGRESSIVE MUSCULAR ATROPHY, ANTERIOR  HORN  CELL  DISEASE,  POST-POLIO
SYNDROME,   CEREBELLAR  DEGENERATION,  DYSTONIA,  HUNTINGTON'S  DISEASE,

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06571-02-5

              

A. 5074                             2

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  AS  OF  JANUARY
FIRST,  TWO  THOUSAND FIFTEEN THAT ARE INDIVIDUALLY CONFIGURED FOR INDI-
VIDUALS TO MEET THEIR SPECIFIC AND UNIQUE MEDICAL,  PHYSICAL  AND  FUNC-
TIONAL 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  SEAT-
ING  AND POSITIONING ITEMS AND ACCESSORIES, AND OTHER SPECIALIZED EQUIP-
MENT SUCH AS STANDING FRAMES AND GAIT TRAINERS AND ACCESSORIES.
  (C) "EMPLOYEE" MEANS A PERSON WHOSE TAXES ARE WITHHELD BY A  QUALIFIED
COMPLEX  REHABILITATION TECHNOLOGY SUPPLIER AND REPORTED TO THE INTERNAL
REVENUE SERVICE.
  (D) "HEALTHCARE COMMON PROCEDURE CODING SYSTEM", OR "HCPCS", MEANS THE
BILLING CODES USED BY MEDICARE AND OVERSEEN BY THE FEDERAL  CENTERS  FOR
MEDICARE  AND MEDICAID SERVICES THAT ARE BASED ON THE CURRENT PROCEDURAL
TECHNOLOGY CODES DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION.
  (E) "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
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.
  (F)  "MIXED HPCS CODES" MEANS HEALTHCARE PROCEDURE CODING SYSTEM CODES
THAT REFER TO A MIX OF COMPLEX REHABILITATION  TECHNOLOGY  PRODUCTS  AND
STANDARD MOBILITY AND ACCESSORY PRODUCTS.
  (G)  "PURE  HPCS CODES" MEANS HEALTHCARE PROCEDURE CODING SYSTEM CODES
THAT REFER EXCLUSIVELY TO COMPLEX REHABILITATION TECHNOLOGY PRODUCTS.
  (H) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  PROFESSIONAL"  MEANS
AN  INDIVIDUAL  WHO IS CERTIFIED AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL
(ATP) BY THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY
OF NORTH AMERICA (RESNA).
  (I) "QUALIFIED COMPLEX REHABILITATION  TECHNOLOGY  SUPPLIER"  MEANS  A
COMPANY OR ENTITY THAT:
  (I) IS ACCREDITED BY A RECOGNIZED ACCREDITING ORGANIZATION;
  (II) IS AN ENROLLED MEDICARE SUPPLIER AND MEETS THE SUPPLIER AND QUAL-
ITY  STANDARDS  ESTABLISHED  FOR  DURABLE  MEDICAL  EQUIPMENT  SUPPLIERS
INCLUDING THOSE FOR COMPLEX REHABILITATION TECHNOLOGY UNDER THE MEDICARE
PROGRAM;
  (III) HAS AT LEAST ONE EMPLOYEE WHO IS A QUALIFIED  COMPLEX  REHABILI-
TATION TECHNOLOGY PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPAC-
ITIES  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 REHABILITATION 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 STOREFRONT LOCATION WITHIN NEW YORK STATE; AND

A. 5074                             3

  (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.
  (J)  "QUALIFIED  HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROFES-
SIONAL LICENSED BY THE STATE EDUCATION DEPARTMENT WHO HAS  NO  FINANCIAL
RELATIONSHIP  WITH A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLI-
ER, INCLUDING BUT NOT LIMITED TO A PHYSICIAN, PHYSICAL THERAPIST,  OCCU-
PATIONAL  THERAPIST,  OR  OTHER  LICENSED  HEALTH  CARE PROFESSIONAL WHO
PERFORMS SPECIALTY EVALUATIONS WITHIN THE PROFESSIONAL'S SCOPE OF  PRAC-
TICE.
  2. REIMBURSEMENT AND BILLING PROCEDURES. (A) TO THE EXTENT PERMISSIBLE
UNDER  FEDERAL  LAW, THE COMMISSIONER SHALL MAINTAIN SPECIFIC REIMBURSE-
MENT AND BILLING  PROCEDURES  WITHIN  THE  STATE  MEDICAID  PROGRAM  FOR
COMPLEX  REHABILITATION  TECHNOLOGY PRODUCTS AND SERVICES TO ENSURE THAT
MEDICAID PAYMENTS FOR SUCH PRODUCTS AND SERVICES PERMIT ADEQUATE  ACCESS
TO  COMPLEX  NEEDS  PATIENTS  AND  TAKES  INTO  ACCOUNT  THE SIGNIFICANT
RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED TO MEET THEIR NEEDS.
  (B) PURSUANT TO PARAGRAPH (A) OF THIS  SUBDIVISION,  THE  COMMISSIONER
SHALL,  NOT LATER THAN OCTOBER FIRST, TWO THOUSAND SEVENTEEN: (I) DESIG-
NATE PRODUCTS AND SERVICES INCLUDED IN MIXED AND PURE HPCS BILLING CODES
AS COMPLEX REHABILITATION TECHNOLOGY, AND AS NEEDED, CREATE NEW  BILLING
CODES  OR  CODE  MODIFIERS FOR SERVICES AND PRODUCTS COVERED FOR COMPLEX
NEEDS PATIENTS; (II) SET MINIMUM STANDARDS CONSISTENT WITH PARAGRAPH (I)
OF SUBDIVISION ONE OF THIS SECTION IN ORDER FOR SUPPLIERS TO BE  CONSID-
ERED  QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIERS ELIGIBLE FOR
MEDICAID REIMBURSEMENT; (III) EXEMPT PRODUCTS OR SERVICES  BILLED  UNDER
MIXED  OR  PURE  HPCS  CODES  FROM  INCLUSION  IN ANY BIDDING, SELECTIVE
CONTRACTING, REQUEST FOR PROPOSAL, OR SIMILAR INITIATIVE;  (IV)  REQUIRE
COMPLEX  NEEDS PATIENTS RECEIVING A COMPLEX REHABILITATION MANUAL WHEEL-
CHAIR, POWER WHEELCHAIR, OR SEATING COMPONENT TO BE EVALUATED BY A QUAL-
IFIED HEALTH CARE PROFESSIONAL AND A  QUALIFIED  COMPLEX  REHABILITATION
TECHNOLOGY  PROFESSIONAL  TO  QUALIFY FOR REIMBURSEMENT (SUCH EVALUATION
SHALL BE EXEMPT FROM ANY HEALTH CARE PROFESSIONAL CAP); (V)  MAKE  OTHER
CHANGES AS NEEDED TO PROTECT ACCESS TO COMPLEX REHABILITATION TECHNOLOGY
FOR  COMPLEX  NEEDS PATIENTS; AND (VI) AFFIRM THAT WITH THE EXCEPTION OF
THOSE ENROLLEES COVERED UNDER A PAYMENT RATE METHODOLOGY OTHERWISE NEGO-
TIATED, PAYMENTS  FOR  COMPLEX  REHABILITATION  TECHNOLOGY  PROVIDED  TO
PATIENTS  ELIGIBLE  FOR MEDICAL ASSISTANCE BY ORGANIZATIONS OPERATING IN
ACCORDANCE WITH THE PROVISIONS  OF  ARTICLE  FORTY-FOUR  OF  THE  PUBLIC
HEALTH  LAW OR BY HEALTH MAINTENANCE ORGANIZATIONS ORGANIZED AND OPERAT-
ING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE INSURANCE  LAW,  SHALL
BE  THE  RATES OF PAYMENT THAT WOULD BE PAID FOR SUCH PAYMENTS UNDER THE
MEDICAL ASSISTANCE PROGRAM AS DETERMINED BY THE COMMISSIONER AND  APPLI-
CABLE TO SERVICES AT THE TIME SUCH SERVICES WERE PROVIDED.
  S  4.  Section 3217-e of the insurance law, as added by chapter 219 of
the laws of 2011, is amended to read as follows:
  S 3217-e. Choice of health care provider. An insurer that  is  subject
to  this  article and requires or provides for designation by an insured
of a participating primary care provider shall  permit  the  insured  to
designate  any  participating  primary care provider who is available to
accept such individual, and in the case of a  child,  shall  permit  the
insured  to  designate  a  physician  (allopathic  or  osteopathic)  who
specializes in pediatrics as the child's primary care provider  if  such
provider participates in the network of the insurer.  EVERY POLICY WHICH
PROVIDES  MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE
SHALL INCLUDE ADEQUATE ACCESS TO  SERVICES  AND  EQUIPMENT  PROVIDED  BY

A. 5074                             4

QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY  SUPPLIERS,  PURSUANT  TO
SECTION THREE HUNDRED SIXTY-SEVEN-J OF  THE  SOCIAL  SERVICES  LAW,  AND
ADOPT THE SUPPLIER STANDARDS CONTAINED THEREIN.
  S  5.  Section 4306-d of the insurance law, as added by chapter 219 of
the laws of 2011, is amended to read as follows:
  S 4306-d. Choice of  health  care  provider.  A  corporation  that  is
subject  to  the provisions of this article and requires or provides for
designation by a subscriber of a  participating  primary  care  provider
shall  permit the subscriber to designate any participating primary care
provider who is available to accept such individual, and in the case  of
a child, shall permit the subscriber to designate a physician (allopath-
ic  or osteopathic) who specializes in pediatrics as the child's primary
care provider if such provider participates in the network of the corpo-
ration. EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL INCLUDE ADEQUATE ACCESS TO SERVICES
AND EQUIPMENT PROVIDED BY QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY
SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF THE SOCIAL
SERVICES LAW, AND ADOPT THE SUPPLIER STANDARDS CONTAINED THEREIN.
  S  6. Section 4403 of the public health law is amended by adding a new
subdivision 9 to read as follows:
  9. EVERY HEALTH MAINTENANCE ORGANIZATION SHALL INCLUDE ADEQUATE ACCESS
TO SERVICES AND EQUIPMENT PROVIDED BY QUALIFIED  COMPLEX  REHABILITATION
TECHNOLOGY SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF
THE  SOCIAL  SERVICES  LAW,  AND  ADOPT THE SUPPLIER STANDARDS CONTAINED
THEREIN.
  S 7. This act shall take effect on the first of January next  succeed-
ing  the  date  on  which it shall have become a law, and shall apply to
contracts and policies issued, renewed, modified or amended on or  after
such effective date.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5074--B

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 12, 2015
                               ___________

Introduced  by  M.  of  A. McDONALD, LAVINE, MONTESANO, MILLER, GUNTHER,
  LIFTON, SIMON, ORTIZ,  GOTTFRIED,  MOSLEY,  TITONE,  FAHY,  DUPREY  --
  Multi-Sponsored  by  --  M.  of A. COOK, HOOPER, McLAUGHLIN, SALADINO,
  SIMANOWITZ -- read once and referred to the  Committee  on  Health  --
  reported  and referred to the Committee on Ways and Means -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee -- again reported from said  committee  with  amend-
  ments, 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:

  Section 1. Short title. This act shall be known and may  be  cited  as
the "complex needs patient act".
  S 2. Legislative intent. It is the intent of the legislature to:
  1.  protect access for complex needs patients to quality complex reha-
bilitation technology;
  2. establish and improve standards  and  safeguards  relating  to  the
provision of complex rehabilitation technology; and
  3.  provide  quality support for complex needs patients to stay in the
home or community setting,  prevent  institutionalization,  and  prevent
hospitalizations and other costly secondary complications.
  S  3. The social services law is amended by adding a new section 367-j
to read as follows:
  S 367-J. COMPLEX NEEDS PATIENT ACT.  1. DEFINITIONS. AS USED  IN  THIS
SECTION:
  (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH SIGNIFICANT PHYS-
ICAL  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 BIFIDA, OSTEO-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06571-04-5
              

A. 5074--B                          2

GENESIS  IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC  LATERAL   SCLEROSIS,
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  AS  OF  JANUARY
FIRST,  TWO  THOUSAND FIFTEEN THAT ARE INDIVIDUALLY CONFIGURED FOR INDI-
VIDUALS TO MEET THEIR SPECIFIC AND UNIQUE MEDICAL,  PHYSICAL  AND  FUNC-
TIONAL 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  SEAT-
ING  AND POSITIONING ITEMS AND ACCESSORIES, AND OTHER SPECIALIZED EQUIP-
MENT SUCH AS STANDING FRAMES AND GAIT TRAINERS AND ACCESSORIES.
  (C) "EMPLOYEE" MEANS A PERSON WHOSE TAXES ARE WITHHELD BY A  QUALIFIED
COMPLEX  REHABILITATION TECHNOLOGY SUPPLIER AND REPORTED TO THE INTERNAL
REVENUE SERVICE.
  (D) "HEALTHCARE COMMON PROCEDURE CODING SYSTEM", OR "HCPCS", MEANS THE
BILLING CODES USED BY MEDICARE AND OVERSEEN BY THE FEDERAL  CENTERS  FOR
MEDICARE  AND MEDICAID SERVICES THAT ARE BASED ON THE CURRENT PROCEDURAL
TECHNOLOGY CODES DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION.
  (E) "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
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.
  (F)  "MIXED  HCPCS  CODES"  MEANS  HEALTHCARE  COMMON PROCEDURE CODING
SYSTEM CODES THAT REFER TO A MIX OF  COMPLEX  REHABILITATION  TECHNOLOGY
PRODUCTS AND STANDARD MOBILITY AND ACCESSORY PRODUCTS.
  (G) "PURE HCPCS CODES" MEANS HEALTHCARE COMMON PROCEDURE CODING SYSTEM
CODES  THAT  REFER  EXCLUSIVELY  TO  COMPLEX  REHABILITATION  TECHNOLOGY
PRODUCTS.
  (H) "QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  PROFESSIONAL"  MEANS
AN  INDIVIDUAL  WHO IS CERTIFIED AS AN ASSISTIVE TECHNOLOGY PROFESSIONAL
(ATP) BY THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY
OF NORTH AMERICA (RESNA).
  (I) "QUALIFIED COMPLEX REHABILITATION  TECHNOLOGY  SUPPLIER"  MEANS  A
COMPANY OR ENTITY THAT:
  (I) IS ACCREDITED BY A RECOGNIZED ACCREDITING ORGANIZATION;
  (II) IS AN ENROLLED MEDICARE SUPPLIER AND MEETS THE SUPPLIER AND QUAL-
ITY  STANDARDS  ESTABLISHED  FOR  DURABLE  MEDICAL  EQUIPMENT  SUPPLIERS
INCLUDING THOSE FOR COMPLEX REHABILITATION TECHNOLOGY UNDER THE MEDICARE
PROGRAM;
  (III) HAS AT LEAST ONE EMPLOYEE WHO IS A QUALIFIED  COMPLEX  REHABILI-
TATION TECHNOLOGY PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPAC-
ITIES  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 REHABILITATION TECHNOLOGY;
  (IV)  REQUIRES  A  QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFES-
SIONAL BE PHYSICALLY PRESENT FOR THE  EVALUATION  AND  DETERMINATION  OF

A. 5074--B                          3

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 STOREFRONT 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.
  (J) "QUALIFIED HEALTH CARE PROFESSIONAL" MEANS A HEALTH  CARE  PROFES-
SIONAL  LICENSED  BY THE STATE EDUCATION DEPARTMENT WHO HAS NO FINANCIAL
RELATIONSHIP WITH A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  SUPPLI-
ER,  INCLUDING BUT NOT LIMITED TO A PHYSICIAN, PHYSICAL THERAPIST, OCCU-
PATIONAL THERAPIST, OR  OTHER  LICENSED  HEALTH  CARE  PROFESSIONAL  WHO
PERFORMS  SPECIALTY EVALUATIONS WITHIN THE PROFESSIONAL'S SCOPE OF PRAC-
TICE.
  2. REIMBURSEMENT AND BILLING PROCEDURES. (A) TO THE EXTENT PERMISSIBLE
UNDER FEDERAL LAW, THE COMMISSIONER SHALL MAINTAIN  SPECIFIC  REIMBURSE-
MENT  AND  BILLING  PROCEDURES  WITHIN  THE  STATE  MEDICAID PROGRAM FOR
COMPLEX REHABILITATION TECHNOLOGY PRODUCTS AND SERVICES TO  ENSURE  THAT
MEDICAID  PAYMENTS FOR SUCH PRODUCTS AND SERVICES PERMIT ADEQUATE ACCESS
TO COMPLEX  NEEDS  PATIENTS  AND  TAKES  INTO  ACCOUNT  THE  SIGNIFICANT
RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED TO MEET THEIR NEEDS.
  (B)  PURSUANT  TO  PARAGRAPH (A) OF THIS SUBDIVISION, THE COMMISSIONER
SHALL, NOT LATER THAN OCTOBER FIRST, TWO THOUSAND SEVENTEEN: (I)  DESIG-
NATE  PRODUCTS  AND  SERVICES  INCLUDED  IN MIXED AND PURE HCPCS BILLING
CODES AS COMPLEX REHABILITATION TECHNOLOGY, AND AS  NEEDED,  CREATE  NEW
BILLING  CODES  OR  CODE MODIFIERS FOR SERVICES AND PRODUCTS COVERED FOR
COMPLEX NEEDS PATIENTS; (II) SET MINIMUM STANDARDS CONSISTENT WITH PARA-
GRAPH (I) OF SUBDIVISION ONE OF THIS SECTION IN ORDER FOR  SUPPLIERS  TO
BE  CONSIDERED  QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY SUPPLIERS
ELIGIBLE FOR MEDICAID REIMBURSEMENT; (III) EXEMPT PRODUCTS  OR  SERVICES
BILLED  UNDER  MIXED  OR PURE HCPCS CODES FROM INCLUSION IN ANY BIDDING,
SELECTIVE CONTRACTING, REQUEST FOR PROPOSAL, OR SIMILAR INITIATIVE; (IV)
REQUIRE COMPLEX NEEDS PATIENTS RECEIVING A COMPLEX REHABILITATION MANUAL
WHEELCHAIR, POWER WHEELCHAIR, OR SEATING COMPONENT TO BE EVALUATED BY  A
QUALIFIED  HEALTH  CARE  PROFESSIONAL  AND A QUALIFIED COMPLEX REHABILI-
TATION TECHNOLOGY PROFESSIONAL TO QUALIFY FOR REIMBURSEMENT (SUCH EVALU-
ATION SHALL BE EXEMPT FROM ANY HEALTH CARE PROFESSIONAL CAP);  (V)  MAKE
OTHER  CHANGES  AS  NEEDED  TO  PROTECT ACCESS TO COMPLEX REHABILITATION
TECHNOLOGY FOR COMPLEX NEEDS PATIENTS; AND (VI)  AFFIRM  THAT  WITH  THE
EXCEPTION  OF  THOSE  ENROLLEES COVERED UNDER A PAYMENT RATE METHODOLOGY
OTHERWISE NEGOTIATED, PAYMENTS  FOR  COMPLEX  REHABILITATION  TECHNOLOGY
PROVIDED  TO  PATIENTS  ELIGIBLE FOR MEDICAL ASSISTANCE BY ORGANIZATIONS
OPERATING IN ACCORDANCE WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW OR BY HEALTH MAINTENANCE ORGANIZATIONS  ORGANIZED  AND
OPERATING  IN  ACCORDANCE WITH ARTICLE FORTY-THREE OF THE INSURANCE LAW,
SHALL BE THE RATES OF PAYMENT THAT WOULD BE PAID FOR SUCH PAYMENTS UNDER
THE MEDICAL ASSISTANCE PROGRAM AS DETERMINED  BY  THE  COMMISSIONER  AND
APPLICABLE TO SERVICES AT THE TIME SUCH SERVICES WERE PROVIDED.
  S  4. Section 4403 of the public health law is amended by adding a new
subdivision 9 to read as follows:
  9. EVERY HEALTH MAINTENANCE ORGANIZATION SHALL INCLUDE ADEQUATE ACCESS
TO SERVICES AND EQUIPMENT PROVIDED BY QUALIFIED  COMPLEX  REHABILITATION
TECHNOLOGY SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF
THE  SOCIAL  SERVICES  LAW,  AND  ADOPT THE SUPPLIER STANDARDS CONTAINED
THEREIN.

A. 5074--B                          4

  S 5. This act shall take effect on the first of January next  succeed-
ing  the  date  on  which it shall have become a law, and shall apply to
contracts and policies issued, renewed, modified or amended on or  after
such effective date.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5074--C

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 12, 2015
                               ___________

Introduced  by  M.  of  A. McDONALD, LAVINE, MONTESANO, MILLER, GUNTHER,
  LIFTON, SIMON, ORTIZ, GOTTFRIED, MOSLEY, TITONE, FAHY, DUPREY,  STECK,
  ARROYO  --  Multi-Sponsored  by  -- M. of A. COOK, HOOPER, McLAUGHLIN,
  SALADINO, SIMANOWITZ -- read once and referred  to  the  Committee  on
  Health  -- reported and referred to the Committee on Ways and Means --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said  committee -- again reported from said committee
  with amendments, ordered reprinted as amended and recommitted to  said
  committee -- recommitted to the Committee on Health in accordance with
  Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee -- reported and
  referred to the Committee on Ways and Means

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:

  Section 1. Short title. This act shall be known and may  be  cited  as
the "complex needs patient act".
  S 2. Legislative intent. It is the intent of the legislature to:
  1.  protect access for complex needs patients to quality complex reha-
bilitation technology;
  2. establish and improve standards  and  safeguards  relating  to  the
provision of complex rehabilitation technology; and
  3.  provide  quality support for complex needs patients to stay in the
home or community setting,  prevent  institutionalization,  and  prevent
hospitalizations and other costly secondary complications.
  S  3. The social services law is amended by adding a new section 367-j
to read as follows:
  S 367-J. COMPLEX NEEDS PATIENT ACT.  1. DEFINITIONS. AS USED  IN  THIS
SECTION:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06571-05-6
              

A. 5074--C                          2

  (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH SIGNIFICANT PHYS-
ICAL  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 BIFIDA, OSTEO-
GENESIS   IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC  LATERAL  SCLEROSIS,
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 AS OF JANUARY
FIRST, TWO THOUSAND FIFTEEN THAT ARE INDIVIDUALLY CONFIGURED  FOR  INDI-
VIDUALS  TO  MEET  THEIR SPECIFIC AND UNIQUE MEDICAL, PHYSICAL AND FUNC-
TIONAL 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 SEAT-
ING AND POSITIONING ITEMS AND ACCESSORIES, AND OTHER SPECIALIZED  EQUIP-
MENT SUCH AS STANDING FRAMES AND GAIT TRAINERS AND ACCESSORIES.
  (C)  "EMPLOYEE" MEANS A PERSON WHOSE TAXES ARE WITHHELD BY A QUALIFIED
COMPLEX REHABILITATION TECHNOLOGY SUPPLIER AND REPORTED TO THE  INTERNAL
REVENUE SERVICE.
  (D) "HEALTHCARE COMMON PROCEDURE CODING SYSTEM", OR "HCPCS", MEANS THE
BILLING  CODES  USED BY MEDICARE AND OVERSEEN BY THE FEDERAL CENTERS FOR
MEDICARE AND MEDICAID SERVICES THAT ARE BASED ON THE CURRENT  PROCEDURAL
TECHNOLOGY CODES DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION.
  (E)  "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
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.
  (F) "MIXED HCPCS  CODES"  MEANS  HEALTHCARE  COMMON  PROCEDURE  CODING
SYSTEM  CODES  THAT  REFER TO A MIX OF COMPLEX REHABILITATION TECHNOLOGY
PRODUCTS AND STANDARD MOBILITY AND ACCESSORY PRODUCTS.
  (G) "PURE HCPCS CODES" MEANS HEALTHCARE COMMON PROCEDURE CODING SYSTEM
CODES  THAT  REFER  EXCLUSIVELY  TO  COMPLEX  REHABILITATION  TECHNOLOGY
PRODUCTS.
  (H)  "QUALIFIED  COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL" MEANS
AN INDIVIDUAL WHO IS CERTIFIED AS AN ASSISTIVE  TECHNOLOGY  PROFESSIONAL
(ATP) BY THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY
OF NORTH AMERICA (RESNA).
  (I)  "QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY SUPPLIER" MEANS A
COMPANY OR ENTITY THAT:
  (I) IS ACCREDITED BY A RECOGNIZED ACCREDITING ORGANIZATION;
  (II) IS AN ENROLLED MEDICARE SUPPLIER AND MEETS THE SUPPLIER AND QUAL-
ITY  STANDARDS  ESTABLISHED  FOR  DURABLE  MEDICAL  EQUIPMENT  SUPPLIERS
INCLUDING THOSE FOR COMPLEX REHABILITATION TECHNOLOGY UNDER THE MEDICARE
PROGRAM;
  (III)  HAS  AT LEAST ONE EMPLOYEE WHO IS A QUALIFIED COMPLEX REHABILI-
TATION TECHNOLOGY PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPAC-
ITIES OF COMPLEX NEEDS PATIENTS IN CONSULTATION WITH A QUALIFIED  HEALTH
CARE  PROFESSIONAL  AND  PARTICIPATE  IN  THE  SELECTION  OF APPROPRIATE

A. 5074--C                          3

COMPLEX REHABILITATION TECHNOLOGY AND PROVIDE TRAINING IN THE PROPER USE
OF THE COMPLEX REHABILITATION 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 STOREFRONT 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.
  (J)  "QUALIFIED  HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROFES-
SIONAL LICENSED BY THE STATE EDUCATION DEPARTMENT WHO HAS  NO  FINANCIAL
RELATIONSHIP  WITH A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLI-
ER, INCLUDING BUT NOT LIMITED TO A PHYSICIAN, PHYSICAL THERAPIST,  OCCU-
PATIONAL  THERAPIST,  OR  OTHER  LICENSED  HEALTH  CARE PROFESSIONAL WHO
PERFORMS SPECIALTY EVALUATIONS WITHIN THE PROFESSIONAL'S SCOPE OF  PRAC-
TICE.
  2. REIMBURSEMENT AND BILLING PROCEDURES. (A) TO THE EXTENT PERMISSIBLE
UNDER  FEDERAL  LAW, THE COMMISSIONER SHALL MAINTAIN SPECIFIC REIMBURSE-
MENT AND BILLING  PROCEDURES  WITHIN  THE  STATE  MEDICAID  PROGRAM  FOR
COMPLEX  REHABILITATION  TECHNOLOGY PRODUCTS AND SERVICES TO ENSURE THAT
MEDICAID PAYMENTS FOR SUCH PRODUCTS AND SERVICES PERMIT ADEQUATE  ACCESS
TO  COMPLEX  NEEDS  PATIENTS  AND  TAKES  INTO  ACCOUNT  THE SIGNIFICANT
RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED TO MEET THEIR NEEDS.
  (B) PURSUANT TO PARAGRAPH (A) OF THIS  SUBDIVISION,  THE  COMMISSIONER
SHALL,  NOT  LATER THAN OCTOBER FIRST, TWO THOUSAND EIGHTEEN: (I) DESIG-
NATE PRODUCTS AND SERVICES INCLUDED IN  MIXED  AND  PURE  HCPCS  BILLING
CODES  AS  COMPLEX  REHABILITATION TECHNOLOGY, AND AS NEEDED, CREATE NEW
BILLING CODES OR CODE MODIFIERS FOR SERVICES AND  PRODUCTS  COVERED  FOR
COMPLEX NEEDS PATIENTS; (II) SET MINIMUM STANDARDS CONSISTENT WITH PARA-
GRAPH  (I)  OF SUBDIVISION ONE OF THIS SECTION IN ORDER FOR SUPPLIERS TO
BE CONSIDERED  QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY  SUPPLIERS
ELIGIBLE  FOR  MEDICAID REIMBURSEMENT; (III) EXEMPT PRODUCTS OR SERVICES
BILLED UNDER MIXED OR PURE HCPCS CODES FROM INCLUSION  IN  ANY  BIDDING,
SELECTIVE CONTRACTING, REQUEST FOR PROPOSAL, OR SIMILAR INITIATIVE; (IV)
REQUIRE COMPLEX NEEDS PATIENTS RECEIVING A COMPLEX REHABILITATION MANUAL
WHEELCHAIR,  POWER WHEELCHAIR, OR SEATING COMPONENT TO BE EVALUATED BY A
QUALIFIED HEALTH CARE PROFESSIONAL AND  A  QUALIFIED  COMPLEX  REHABILI-
TATION TECHNOLOGY PROFESSIONAL TO QUALIFY FOR REIMBURSEMENT (SUCH EVALU-
ATION  SHALL  BE EXEMPT FROM ANY HEALTH CARE PROFESSIONAL CAP); (V) MAKE
OTHER CHANGES AS NEEDED TO  PROTECT  ACCESS  TO  COMPLEX  REHABILITATION
TECHNOLOGY  FOR  COMPLEX  NEEDS  PATIENTS; AND (VI) AFFIRM THAT WITH THE
EXCEPTION OF THOSE ENROLLEES COVERED UNDER A  PAYMENT  RATE  METHODOLOGY
OTHERWISE  NEGOTIATED,  PAYMENTS  FOR  COMPLEX REHABILITATION TECHNOLOGY
PROVIDED TO PATIENTS ELIGIBLE FOR MEDICAL  ASSISTANCE  BY  ORGANIZATIONS
OPERATING IN ACCORDANCE WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF THE
PUBLIC  HEALTH  LAW OR BY HEALTH MAINTENANCE ORGANIZATIONS ORGANIZED AND
OPERATING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE  INSURANCE  LAW,
SHALL BE THE RATES OF PAYMENT THAT WOULD BE PAID FOR SUCH PAYMENTS UNDER
THE  MEDICAL  ASSISTANCE  PROGRAM  AS DETERMINED BY THE COMMISSIONER AND
APPLICABLE TO SERVICES AT THE TIME SUCH SERVICES WERE PROVIDED.
  S 4. Section 4403 of the public health law is amended by adding a  new
subdivision 9 to read as follows:

A. 5074--C                          4

  9. EVERY HEALTH MAINTENANCE ORGANIZATION SHALL INCLUDE ADEQUATE ACCESS
TO  SERVICES  AND EQUIPMENT PROVIDED BY QUALIFIED COMPLEX REHABILITATION
TECHNOLOGY SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF
THE SOCIAL SERVICES LAW, AND  ADOPT  THE  SUPPLIER  STANDARDS  CONTAINED
THEREIN.
  S  5. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law,  and  shall  apply  to
contracts  and policies issued, renewed, modified or amended on or after
such effective date.