Requires specific Medicaid insurance codes related to complex needs patients' therapy and treatment; requires managed care contracts to comply with certain reimbursement rates

2 Co-sponsors

• Tony Avella
• Joseph E. Robach

Title of bill

An act to amend the social services law and the public health law, in relation to preserving access to quality complex rehabilitation technology for patients with complex medical needs

Purpose or general idea of bill

To maintain access to quality complex rehabilitation equipment for patients with specific diagnoses and physical conditions who require individually configured equipment and technology to sustain independence and avoid institutionalization. The bill will also safeguard the configuration, delivery and repair of customized technology and equipment by establishing qualifications currently sought administratively through prior authorization and administrative review.

Summary of specific provisions

Section 1 sets forth the title of the Act as the "Complex Needs Patient Act".

Section 2 is the legislative intent of maintaining access to complex technology and supportive services.

Section 3 amends the social service law by adding a new section which provides definitions for the individual's possible eligible for complex technology equipment, the type of equipment and components of equipment addressed and the qualifications of individuals appropriate to fit and individually configure such equipment.

Section 4 amends the public health to require all health maintenance organization to provide adequate access to services and equipment provided by qualified complex rehabilitation technology suppliers.

Section 5 provides the effective date.

Justification

The bill distinguishes complex rehabilitation technology and the need for customized, sophisticated technology by a small portion of the general population, who, without access to such equipment could not maintain mobility, quality of life or independence. Much of the population requiring such complex rehabilitation technology were previously exempt from being enrolled in managed care insurance plans and access to appropriate, high quality equipment was determined through a stringent evaluation and prior authorization process administered by the State Department of Health. The Department required physician authorization, independent evaluation of the individual's needs by licensed therapists in an independent clinic setting, that the supplier complete and submit a request for prior authorization, that the supplier operate a store front in New York State, that the supplier employ licensed and trained professionals who customize and fit patients in person. The bill is intended to preserve as much of that process as determined necessary by the department for specific complex needs patients and for certain complex need technology. The bill does not establish new reimbursement rates, but established the Department's authority to maintain adequate rates.

The bill will protect existing prior authorization and approval procedures.

Prior legislative history

A7257-A / S7252 laws of 2013-14

Fiscal implications

None

Effective date

The first of January next succeeding the date on which it shall have become law with provisions.