What's happening
This bill requires Medicaid to provide specific coverage and billing procedures for complex rehabilitation technology for patients with significant medical needs.
Why it matters
Clarifies definitions and standards. for who qualifies as a “complex needs patient,” what constitutes “complex rehabilitation technology,” and who is eligible to provide and prescribe this technology—ensuring that only highly specialized equipment and qualified professionals are involved.
Mandates rigorous supplier requirements,. such as accreditation, in-state presence, service/repair capacity, and direct patient evaluation—raising the bar for quality and accountability among providers.
Requires Medicaid to maintain distinct billing and reimbursement procedures. for this technology, aiming to protect patient access and support the higher costs, expertise, and infrastructure needed to serve people with complex medical needs.
Facilitates timely adoption of new Medicare billing codes. for complex rehab technology and allows the state to set minimum payment rates for managed care organizations—potentially speeding up patient access to new equipment and preventing cost-driven barriers.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Medicaid Tech Coverage Expansion
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 39
No co-sponsors yet.
History
- Substituted by A7492
- Ordered to third reading cal.1399
- Committee discharged and committed to rules
- Reported and committed to finance
- Referred to health
Companion bills
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Expand Medicaid Rehab Coverage
In Senate Committee · Finance · Sponsor James Skoufis
Expand Medicaid Rehab Coverage
Vetoed · Sponsor Phil Steck
Expand Medicaid Rehab Tech Coverage
In Assembly Committee · Ways And Means · Sponsor Phil Steck
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5741
2019-2020 Regular Sessions
IN SENATE
May 14, 2019
Introduced by Sen. SKOUFIS -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to coverage and billing procedures in the Medicaid program for complex rehabilitation technology for patients with complex medical needs
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The social services law is amended by adding a new section 367-j to read as follows:
§ 367-j. Complex rehabilitation technology; coverage and safeguards. 1. Definitions. As used in this section:
(a) "Complex needs patient" means a medical assistance enrollee with significant physical 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, osteogenesis 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 that are individually configured for individuals to meet their specific and unique medical, physical and functional 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 seating and positioning items and accessories, and other specialized equipment such as standing frames and gait trainers and accessories.
(c) "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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11457-02-9
S. 5741 2
adapting the device so that the device is consistent with the individual's medical condition, physical and functional needs and capabilities, body size, period of need and intended use as determined by an assessment or evaluation by a qualified health care professional.
(d) "Qualified complex rehabilitation technology professional" means an individual who is certified as an assistive technology professional by a nationally-recognized rehabilitation engineering and assistive technology society.
(e) "Qualified complex rehabilitation technology supplier" means a company or entity that:
(i) is accredited by a nationally-recognized accrediting organization;
(ii) is an enrolled supplier for durable medical equipment under the federal medicare program and the medical assistance program under this title;
(iii) has at least one qualified complex rehabilitation technology professional available to analyze the needs and capacities 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 professional 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 retail vending 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.
(f) "Qualified health care professional" means a health care professional licensed or otherwise authorized to practice under title eight of the education law, acting within his or her scope of practice who has no financial relationship with the complex rehabilitation technology supplier.
2. Reimbursement and billing procedures. (a) The commissioner shall maintain specific reimbursement and billing procedures under this title for complex rehabilitation technology products to ensure that Medicaid payments for such products permit adequate access to such products and services for complex needs patients and take into account the significant resources, infrastructure, and staff needed.
(b) The commissioner shall monitor the addition of new billing codes for complex rehabilitation technology by the medicare program and shall expeditiously incorporate such codes under this subdivision.
(c) Where reimbursement rates for complex rehabilitation technology products provided under section forty-four hundred three-f of the public health law or section three hundred sixty-four-j of this title are determined by a managed care organization, they shall be determined consistent with this subdivision. The commissioner may establish minimum benchmark reimbursement rates to be paid by managed care organizations under this paragraph.
§ 2. This act shall take effect on the first of April next succeeding the date on which it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to coverage and billing procedures in the Medicaid program for complex rehabilitation technology for patients with complex medical needs
Purpose
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 config- uration, delivery and repair of customized technology and equipment by establishing qualifications currently sought administratively through prior authorization and administrative review.
Summary of provisions
Section 1 amends the social service law by adding a new section, 367-j. Subdivision 1 defines complex needs patients and complex rehabilitation technology, as well as the required qualifications of individuals and entities eligible to configure and supply such equipment.
Subdivision 2 directs the commissioner to monitor the addition of new billing codes for complex rehabilitation technology by the Medicare program and to expeditiously add these codes to the Medicaid program.
Section 2 provides the effective date.
Justification
A small portion of the population depends on medically necessary, indi- vidually configured equipment, known as complex rehabilitation technolo- gy (CRT), to maintain their mobility, quality of life, and independence. CRT includes individually configured manual and power wheelchairs, adap- tive seating and position items, and other equipment designed to meet a patient's unique needs. For individuals with significant physical or functional impairments, having the appropriate equipment can mean the difference between constant pain and immobility and an active, fulfill- ing life.
The existing process to qualify for and configure CRT for Medicaid bene- ficiaries, which this bill codifies, ensures that appropriately diag- nosed patients are able to access CRT, and that CRT suppliers meet stringent requirements to protect quality and access to service and repairs.
Since CRT is a rapidly developing industry, the new technology often does not fit into existing durable medical equipment (DME) billing cate- gories. For example, a powered wheelchair with a custom-molded seat that supports the unique shape and pressure points of an individual with severe spinal curvature is not interchangeable with an off-the-shelf model that will cause sores, pain, and immobility. Thus, a crucial part of protecting access to this highly specialized equipment is keeping the billing codes used by Medicaid updated with the new codes added for CRT to the Medicare billing system. The timely addition of new billing codes that conform to Medicare changes will remove a hurdle many Medicaid beneficiaries face when trying to access the equipment they need.
Legislative history
2017/18: A10604 passed Assembly Same as A.6120-B of 2018; Veto 165 Similar to A. 5074-C of 2016; Veto 270
Fiscal implications
Undetermined.
Effective date
The first of April next succeeding the date on which it shall have become law; provided that effective immediately, the commissioner of health shall make regulations and take other actions reasonably neces- sary to implement this act on that date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.