Bill Text: NY S08142 | 2015-2016 | General Assembly | Introduced
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
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 of26those enrollees covered under a payment rate methodology otherwise nego-27tiated, payments for complex rehabilitation technology provided toEXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15880-01-6S. 8142 2 1patients eligible for medical assistance by organizations operating in2accordance with the provisions of article forty-four of the public3health law or by health maintenance organizations organized and operat-4ing in accordance with article forty-three of the insurance law, shall5be the rates of payment that would be paid for such payments under the6medical assistance program as determined by the commissioner and appli-7cable 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.