S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3651
                              2015-2016 Regular Sessions
                                   I N  S E N A T E
                                   February 13, 2015
                                      ___________
       Introduced  by  Sen.  ORTT  --  read twice and ordered printed, and when
         printed to be committed 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:
    1    Section 1. Short title. This act shall be known and may  be  cited  as
    2  the "complex needs patient act".
    3    S 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    S  3. The social services law is amended by adding a new section 367-j
   12  to read as follows:
   13    S 367-J. COMPLEX NEEDS PATIENT ACT.  1. DEFINITIONS. AS USED  IN  THIS
   14  SECTION:
   15    (A) "COMPLEX NEEDS PATIENT" MEANS AN INDIVIDUAL WITH SIGNIFICANT PHYS-
   16  ICAL  OR  FUNCTIONAL  IMPAIRMENT  RESULTING  FROM A MEDICAL CONDITION OR
   17  DISEASE INCLUDING, BUT NOT LIMITED TO:  SPINAL  CORD  INJURY,  TRAUMATIC
   18  BRAIN  INJURY,  CEREBRAL PALSY, MUSCULAR DYSTROPHY, SPINA BIFIDA, OSTEO-
   19  GENESIS  IMPERFECTA,  ARTHROGRYPOSIS,  AMYOTROPHIC  LATERAL   SCLEROSIS,
   20  MULTIPLE   SCLEROSIS,   DEMYELINATING   DISEASE,  MYELOPATHY,  MYOPATHY,
   21  PROGRESSIVE MUSCULAR ATROPHY, ANTERIOR  HORN  CELL  DISEASE,  POST-POLIO
   22  SYNDROME,   CEREBELLAR  DEGENERATION,  DYSTONIA,  HUNTINGTON'S  DISEASE,
   23  SPINOCEREBELLAR DISEASE, AND CERTAIN TYPES OF AMPUTATION,  PARALYSIS  OR
   24  PARESIS.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD07851-02-5
       S. 3651                             2
    1    (B)  "COMPLEX  REHABILITATION TECHNOLOGY" MEANS PRODUCTS CLASSIFIED AS
    2  DURABLE MEDICAL EQUIPMENT WITHIN THE  MEDICARE  PROGRAM  AS  OF  JANUARY
    3  FIRST,  TWO THOUSAND FOURTEEN THAT ARE INDIVIDUALLY CONFIGURED FOR INDI-
    4  VIDUALS TO MEET THEIR SPECIFIC AND UNIQUE MEDICAL,  PHYSICAL  AND  FUNC-
    5  TIONAL NEEDS AND CAPACITIES FOR BASIC AND FUNCTIONAL ACTIVITIES OF DAILY
    6  LIVING.  SUCH PRODUCTS INCLUDE, BUT ARE NOT LIMITED TO: MANUAL AND POWER
    7  WHEELCHAIRS AND ACCESSORIES, ADAPTIVE SEATING AND POSITIONING ITEMS  AND
    8  ACCESSORIES, AND OTHER SPECIALIZED EQUIPMENT SUCH AS STANDING FRAMES AND
    9  GAIT TRAINERS AND ACCESSORIES.
   10    (C)  "EMPLOYEE" MEANS A PERSON WHOSE TAXES ARE WITHHELD BY A QUALIFIED
   11  COMPLEX REHABILITATION TECHNOLOGY SUPPLIER AND REPORTED TO THE  INTERNAL
   12  REVENUE SERVICE.
   13    (D) "HEALTHCARE COMMON PROCEDURE CODING SYSTEM", OR "HCPCS", MEANS THE
   14  BILLING  CODES  USED BY MEDICARE AND OVERSEEN BY THE FEDERAL CENTERS FOR
   15  MEDICARE AND MEDICAID SERVICES THAT ARE BASED ON THE CURRENT  PROCEDURAL
   16  TECHNOLOGY CODES DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION.
   17    (E)  "INDIVIDUALLY  CONFIGURED"  MEANS  A DEVICE WITH A COMBINATION OF
   18  SIZES, FEATURES, ADJUSTMENTS OR MODIFICATIONS THAT IS  CUSTOMIZED  BY  A
   19  QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY  SUPPLIER  FOR A SPECIFIC
   20  INDIVIDUAL BY MEASURING, FITTING, PROGRAMMING, ADJUSTING OR ADAPTING THE
   21  DEVICE SO THAT THE DEVICE IS CONSISTENT WITH  THE  INDIVIDUAL'S  MEDICAL
   22  CONDITION,  PHYSICAL  AND  FUNCTIONAL NEEDS AND CAPABILITIES, BODY SIZE,
   23  PERIOD OF NEED AND INTENDED USE AS DETERMINED BY AN ASSESSMENT OR EVALU-
   24  ATION BY A QUALIFIED HEALTH CARE PROFESSIONAL.
   25    (F) "MIXED HCPCS CODES" MEANS CODES THAT REFER TO  A  MIX  OF  COMPLEX
   26  REHABILITATION  TECHNOLOGY  PRODUCTS AND STANDARD MOBILITY AND ACCESSORY
   27  PRODUCTS.
   28    (G) "PURE HCPCS CODES" MEANS CODES THAT REFER EXCLUSIVELY  TO  COMPLEX
   29  REHABILITATION TECHNOLOGY PRODUCTS.
   30    (H)  "QUALIFIED  COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL" MEANS
   31  AN INDIVIDUAL WHO IS CERTIFIED AS AN ASSISTIVE  TECHNOLOGY  PROFESSIONAL
   32  (ATP) BY THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY
   33  OF NORTH AMERICA.
   34    (I)  "QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY SUPPLIER" MEANS A
   35  COMPANY OR ENTITY THAT:
   36    (I) IS ACCREDITED BY A RECOGNIZED ACCREDITING ORGANIZATION;
   37    (II) IS AN ENROLLED MEDICARE SUPPLIER AND MEETS THE SUPPLIER AND QUAL-
   38  ITY  STANDARDS  ESTABLISHED  FOR  DURABLE  MEDICAL  EQUIPMENT  SUPPLIERS
   39  INCLUDING THOSE FOR COMPLEX REHABILITATION TECHNOLOGY UNDER THE MEDICARE
   40  PROGRAM;
   41    (III)  HAS  AT LEAST ONE EMPLOYEE WHO IS A QUALIFIED COMPLEX REHABILI-
   42  TATION TECHNOLOGY PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND CAPAC-
   43  ITIES OF COMPLEX NEEDS PATIENTS IN CONSULTATION WITH A QUALIFIED  HEALTH
   44  CARE  PROFESSIONAL  AND  PARTICIPATE  IN  THE  SELECTION  OF APPROPRIATE
   45  COMPLEX REHABILITATION TECHNOLOGY AND PROVIDE TRAINING IN THE PROPER USE
   46  OF THE COMPLEX REHABILITATION TECHNOLOGY;
   47    (IV) REQUIRES A QUALIFIED COMPLEX  REHABILITATION  TECHNOLOGY  PROFES-
   48  SIONAL  BE  PHYSICALLY  PRESENT  FOR THE EVALUATION AND DETERMINATION OF
   49  APPROPRIATE  COMPLEX  REHABILITATION  TECHNOLOGY   FOR   COMPLEX   NEEDS
   50  PATIENTS;
   51    (V)  HAS  THE  CAPABILITY  TO  PROVIDE SERVICE AND REPAIR BY QUALIFIED
   52  TECHNICIANS FOR ALL COMPLEX REHABILITATION TECHNOLOGY IT SELLS;
   53    (VI) HAS AT LEAST ONE STOREFRONT LOCATION WITHIN NEW YORK STATE; AND
   54    (VII) PROVIDES WRITTEN INFORMATION REGARDING HOW  TO  RECEIVE  SERVICE
   55  AND  REPAIR  OF  COMPLEX  REHABILITATION TECHNOLOGY TO THE COMPLEX NEEDS
   56  PATIENT AT THE TIME SUCH TECHNOLOGY IS DELIVERED.
       S. 3651                             3
    1    (J) "QUALIFIED HEALTH CARE PROFESSIONAL" MEANS A HEALTH  CARE  PROFES-
    2  SIONAL  LICENSED  BY THE STATE EDUCATION DEPARTMENT WHO HAS NO FINANCIAL
    3  RELATIONSHIP WITH A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY  SUPPLI-
    4  ER,  INCLUDING BUT NOT LIMITED TO A PHYSICIAN, PHYSICAL THERAPIST, OCCU-
    5  PATIONAL  THERAPIST,  OR  OTHER  LICENSED  HEALTH  CARE PROFESSIONAL WHO
    6  PERFORMS SPECIALTY EVALUATIONS WITHIN THE PROFESSIONAL'S SCOPE OF  PRAC-
    7  TICE.
    8    2. REIMBURSEMENT AND BILLING PROCEDURES. (A) TO THE EXTENT PERMISSIBLE
    9  UNDER  FEDERAL LAW, THE COMMISSIONER SHALL ESTABLISH SPECIFIC REIMBURSE-
   10  MENT AND BILLING  PROCEDURES  WITHIN  THE  STATE  MEDICAID  PROGRAM  FOR
   11  COMPLEX  REHABILITATION  TECHNOLOGY PRODUCTS AND SERVICES TO ENSURE THAT
   12  MEDICAID PAYMENTS FOR SUCH PRODUCTS AND SERVICES PERMIT ADEQUATE  ACCESS
   13  TO  COMPLEX  NEEDS  PATIENTS  AND  TAKES  INTO  ACCOUNT  THE SIGNIFICANT
   14  RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED TO MEET THEIR NEEDS.
   15    (B) WHEN ESTABLISHING REIMBURSEMENT AND BILLING PROCEDURES PURSUANT TO
   16  PARAGRAPH (A) OF THIS SUBDIVISION, THE  COMMISSIONER  SHALL,  NOT  LATER
   17  THAN  OCTOBER  FIRST,  TWO  THOUSAND SIXTEEN: (I) DESIGNATE PRODUCTS AND
   18  SERVICES INCLUDED IN MIXED AND PURE HCPCS BILLING CODES AS COMPLEX REHA-
   19  BILITATION TECHNOLOGY, AND AS NEEDED, CREATE NEW BILLING CODES  OR  CODE
   20  MODIFIERS  FOR SERVICES AND PRODUCTS COVERED FOR COMPLEX NEEDS PATIENTS;
   21  (II) SET MINIMUM STANDARDS CONSISTENT WITH PARAGRAPH (I) OF  SUBDIVISION
   22  ONE  OF  THIS  SECTION IN ORDER FOR SUPPLIERS TO BE CONSIDERED QUALIFIED
   23  COMPLEX  REHABILITATION  TECHNOLOGY  SUPPLIERS  ELIGIBLE  FOR   MEDICAID
   24  REIMBURSEMENT;  (III)  EXEMPT PRODUCTS OR SERVICES BILLED UNDER MIXED OR
   25  PURE HCPCS CODES FROM INCLUSION IN ANY BIDDING,  SELECTIVE  CONTRACTING,
   26  REQUEST  FOR PROPOSAL, OR SIMILAR INITIATIVE; (IV) REQUIRE COMPLEX NEEDS
   27  PATIENTS RECEIVING A COMPLEX  REHABILITATION  MANUAL  WHEELCHAIR,  POWER
   28  WHEELCHAIR,  OR  SEATING COMPONENT TO BE EVALUATED BY A QUALIFIED HEALTH
   29  CARE PROFESSIONAL AND  A  QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY
   30  PROFESSIONAL  TO  QUALIFY  FOR  REIMBURSEMENT; (V) MAKE OTHER CHANGES AS
   31  NEEDED TO  PROTECT  ACCESS  TO  COMPLEX  REHABILITATION  TECHNOLOGY  FOR
   32  COMPLEX NEEDS PATIENTS; AND (VI) AFFIRM THAT WITH THE EXCEPTION OF THOSE
   33  ENROLLEES COVERED UNDER A PAYMENT RATE METHODOLOGY OTHERWISE NEGOTIATED,
   34  PAYMENTS  FOR  COMPLEX  REHABILITATION  TECHNOLOGY  PROVIDED TO PATIENTS
   35  ELIGIBLE FOR MEDICAL ASSISTANCE BY ORGANIZATIONS OPERATING IN ACCORDANCE
   36  WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR BY
   37  HEALTH MAINTENANCE ORGANIZATIONS ORGANIZED AND OPERATING  IN  ACCORDANCE
   38  WITH  ARTICLE  FORTY-THREE  OF  THE INSURANCE LAW, SHALL BE THE RATES OF
   39  PAYMENT THAT WOULD BE PAID FOR SUCH PAYMENTS UNDER THE  MEDICAL  ASSIST-
   40  ANCE  PROGRAM  AS  DETERMINED  BY  THE  COMMISSIONER  AND  APPLICABLE TO
   41  SERVICES AT THE TIME SUCH SERVICES WERE PROVIDED.
   42    S 4. Section 3217-e of the insurance law, as added by chapter  219  of
   43  the laws of 2011, is amended to read as follows:
   44    S  3217-e.  Choice of health care provider. An insurer that is subject
   45  to this article and requires or provides for designation by  an  insured
   46  of  a  participating  primary  care provider shall permit the insured to
   47  designate any participating primary care provider who  is  available  to
   48  accept  such  individual,  and  in the case of a child, shall permit the
   49  insured  to  designate  a  physician  (allopathic  or  osteopathic)  who
   50  specializes  in  pediatrics as the child's primary care provider if such
   51  provider participates in the network of the insurer.  EVERY POLICY WHICH
   52  PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE  COVERAGE
   53  SHALL  INCLUDE  ADEQUATE  ACCESS  TO  SERVICES AND EQUIPMENT PROVIDED BY
   54  QUALIFIED  COMPLEX  REHABILITATION  TECHNOLOGY  SUPPLIERS,  PURSUANT  TO
   55  SECTION  THREE  HUNDRED  SIXTY-SEVEN-J  OF  THE SOCIAL SERVICES LAW, AND
   56  ADOPT THE SUPPLIER STANDARDS CONTAINED THEREIN.
       S. 3651                             4
    1    S 5. Section 4306-d of the insurance law, as added by chapter  219  of
    2  the laws of 2011, is amended to read as follows:
    3    S  4306-d.  Choice  of  health  care  provider.  A corporation that is
    4  subject to the provisions of this article and requires or  provides  for
    5  designation  by  a  subscriber  of a participating primary care provider
    6  shall permit the subscriber to designate any participating primary  care
    7  provider  who is available to accept such individual, and in the case of
    8  a child, shall permit the subscriber to designate a physician (allopath-
    9  ic or osteopathic) who specializes in pediatrics as the child's  primary
   10  care provider if such provider participates in the network of the corpo-
   11  ration.  EVERY  POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
   12  COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE ADEQUATE  ACCESS  TO  SERVICES
   13  AND  EQUIPMENT  PROVIDED  BY QUALIFIED COMPLEX REHABILITATION TECHNOLOGY
   14  SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF THE SOCIAL
   15  SERVICES LAW, AND ADOPT THE SUPPLIER STANDARDS CONTAINED THEREIN.
   16    S 6. Section 4403 of the public health law is amended by adding a  new
   17  subdivision 9 to read as follows:
   18    9. EVERY HEALTH MAINTENANCE ORGANIZATION SHALL INCLUDE ADEQUATE ACCESS
   19  TO  SERVICES  AND EQUIPMENT PROVIDED BY QUALIFIED COMPLEX REHABILITATION
   20  TECHNOLOGY SUPPLIERS, PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-J OF
   21  THE SOCIAL SERVICES LAW, AND  ADOPT  THE  SUPPLIER  STANDARDS  CONTAINED
   22  THEREIN.
   23    S  7. This act shall take effect on the first of January next succeed-
   24  ing the date on which it shall have become a law,  and  shall  apply  to
   25  contracts  and policies issued, renewed, modified or amended on or after
   26  such effective date.