Bill Text: NY S08142 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to the reimbursement rates for complex rehabilitation technology products and services by managed care organizations.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Engrossed - Dead) 2016-06-17 - referred to health [S08142 Detail]

Download: New_York-2015-S08142-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          8142
                    IN SENATE
                                      June 14, 2016
                                       ___________
        Introduced  by  Sen.  ORTT  --  read twice and ordered printed, and when
          printed to be committed to the Committee on Rules
        AN ACT to amend the social services law, in relation to complex rehabil-
          itation technology products and services; and  to  repeal  subdivision
          nine of section 4403 of the public health law relating thereto
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Paragraph (b) of subdivision 2  of  section  367-j  of  the
     2  social  services law, as added by a chapter of the laws of 2016 amending
     3  the social services law and the public health law relating to preserving
     4  access to quality complex rehabilitation technology  for  patients  with
     5  complex medical needs, as proposed in legislative bills numbers S.3651-D
     6  and A. 5074-C, is amended to read as follows:
     7    (b)  Pursuant  to  paragraph (a) of this subdivision, the commissioner
     8  shall, not later than October first, two thousand eighteen:  (i)  desig-
     9  nate  products  and  services  included  in mixed and pure HCPCS billing
    10  codes as complex  rehabilitation  technology,  and  as  [needed]  deemed
    11  necessary  and appropriate by the commissioner, create new billing codes
    12  or code modifiers for services and products covered  for  complex  needs
    13  patients;  (ii)  set  minimum standards consistent with paragraph (i) of
    14  subdivision one of this section in order for suppliers to be  considered
    15  qualified complex rehabilitation technology suppliers eligible for medi-
    16  caid reimbursement; (iii) exempt products or services billed under mixed
    17  or  pure  HCPCS codes from inclusion in any bidding, selective contract-
    18  ing, request for proposal, or similar initiative; (iv)  require  complex
    19  needs  patients  receiving  a  complex rehabilitation manual wheelchair,
    20  power wheelchair, or seating component to be evaluated  by  a  qualified
    21  health care professional and a qualified complex rehabilitation technol-
    22  ogy  professional to qualify for reimbursement (such evaluation shall be
    23  exempt from any health care professional cap); and (v) make other chang-
    24  es as needed to protect access to complex rehabilitation technology  for
    25  complex  needs  patients[;  and  (vi)  affirm that with the exception of
    26  those enrollees covered under a payment rate methodology otherwise nego-
    27  tiated, payments  for  complex  rehabilitation  technology  provided  to

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15880-01-6
        S. 8142                             2

     1  patients  eligible  for medical assistance by organizations operating in
     2  accordance with the provisions  of  article  forty-four  of  the  public
     3  health  law or by health maintenance organizations organized and operat-
     4  ing  in  accordance with article forty-three of the insurance law, shall
     5  be the rates of payment that would be paid for such payments  under  the
     6  medical  assistance program as determined by the commissioner and appli-
     7  cable to services  at  the  time  such  services  were  provided.].  The
     8  reimbursement rate paid to providers for complex rehabilitation technol-
     9  ogy  products  and  services  by  managed care organizations pursuant to
    10  section forty-four hundred three-f of the public health law and  section
    11  three  hundred  sixty-four-j of this title shall be determined by agree-
    12  ment between the provider and managed care organization. The  amount  of
    13  any  reimbursement  rate  increase  resulting from the implementation of
    14  this section shall be specifically identified in the managed care organ-
    15  ization's premiums and the commissioner  shall  provide  for  the  expe-
    16  ditious  increase of such premiums to ensure the actuarial soundness and
    17  adequacy of such premiums and to accurately account for the cost of  the
    18  amounts  paid  to providers pursuant to this section.  The commissioner,
    19  in his or her judgment, may establish a minimum benchmark  reimbursement
    20  rate for managed care organizations to pay contracted providers pursuant
    21  to this section, provided such benchmark rate is specifically identified
    22  and included in the managed care organizations premiums.
    23    §  2.  Subdivision  9  of  section  4403  of  the public health law is
    24  repealed.
    25    § 3. This act shall take effect on the  same  date  and  in  the  same
    26  manner as a chapter of the laws of 2016 amending the social services law
    27  and  the  public  health  law  relating  to preserving access to quality
    28  complex rehabilitation technology  for  patients  with  complex  medical
    29  needs,  as  proposed in legislative bills numbers S.3651-D and A. 5074-C
    30  takes effect.