HF 562 (LSB 2297YH (6) 90)

HOUSE FILE 562

BY  BEST

A BILL FOR

An Act relating to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514M.1  Definitions.
   For purposes of this chapter, unless the context otherwise requires:
   1.  “Commissioner” means the commissioner of insurance.
   2.  “Complex rehabilitation technology wheelchair” means a complex rehabilitation manual or power wheelchair, classified by Medicare as durable medical equipment, that is individually configured for a patient to meet the patient’s specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary, and includes the options and accessories related to the complex rehabilitation manual or power wheelchair.
   3.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   4.  “Department” means the department of health and human services.
   5.  “Health care professional” means the same as defined in section 514J.102.
   6.  “Health carrier” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services.
   7.  “Medical assistance” means the same as defined in section 249A.2.
   8.  “Patient” means an individual who resides in the state, who is a recipient, and who has a diagnosis or medical condition that results in significant physical impairment or functional limitation.
   9.  “Qualified complex rehabilitation technology professional” means an individual who is certified as an assistive technology professional by the rehabilitation engineering and assistive technology society of North America.
   10.  “Qualified complex rehabilitation technology wheelchair supplier” or “qualified supplier” means an entity that meets all of the following criteria:
   a.  The entity is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology wheelchairs.
   b.  The entity employs at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of a patient or a covered person in consultation with the patient’s or covered person’s prescribing health care professional, to participate in the selection of an appropriate complex rehabilitation technology wheelchair for the needs and capacities of the patient or the covered person, and to provide training in the proper use of the complex rehabilitation technology wheelchair.
   c.  The entity requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of an appropriate complex rehabilitation technology wheelchair for a patient or a covered person.
   d.  The entity has the capability to provide service and repairs, performed by qualified technicians, for all complex rehabilitation technology wheelchairs sold by the qualified supplier.
   e.  At the time of delivery of a complex rehabilitation technology wheelchair to a patient or a covered person, the entity provides written information that explains how the patient or covered person may receive service, repairs, and annual preventative maintenance for the complex rehabilitation technology wheelchair.
   11.  “Recipient” means a person who receives medical assistance under chapter 249A.
   12.  “Third-party payor” means health carriers and other entities that provide a plan of health insurance or health care benefits.
    Sec. 2.  NEW SECTION.  514M.2  Complex rehabilitation technology wheelchairs —— service and repairs.
   1.  Beginning January 1, 2024, a qualified complex rehabilitation technology wheelchair supplier that provides a complex rehabilitation technology wheelchair to a patient or to a covered person shall be required to provide service and repairs of the complex rehabilitation technology wheelchair as requested by the patient or the covered person, or the patient’s or covered person’s prescribing health care professional, except in the following circumstances:
   a.  The patient or covered person moves out of state after receiving the complex rehabilitation technology wheelchair.
   b.  The patient or covered person presents a safety risk to any of the qualified supplier’s staff members.
   c.  The patient or covered person is no longer a recipient or a covered person.
   2.  A third-party payor shall not require any of the following in order for a qualified complex rehabilitation technology wheelchair supplier to provide service and repairs under this section:
   a.  Prior authorization.
   b.  Documentation of continued medical necessity.
   3.  Documentation of all service and repairs completed by a qualified complex rehabilitation technology wheelchair supplier under this section shall be maintained by the qualified supplier. The documentation shall not be subject to audit by a third-party payor.
    Sec. 3.  NEW SECTION.  514M.3  Complex rehabilitation technology wheelchairs —— annual preventative maintenance.
   1.  Beginning July 1, 2024, a qualified complex rehabilitation technology wheelchair supplier that provides a complex rehabilitation technology wheelchair to a patient or to a covered person shall be required to offer annual preventative maintenance on the complex rehabilitation technology wheelchair except in the following circumstances:
   a.  The patient or covered person moves out of state after receiving the complex rehabilitation technology wheelchair.
   b.  The patient or covered person presents a safety risk to any of the qualified supplier’s staff members.
   c.  The patient or covered person is no longer a recipient or a covered person.
   2.  All preventative maintenance shall be performed by a qualified technician who is an employee of the qualified complex rehabilitation technology wheelchair supplier.
   3.  All third-party payors shall ensure that the annual preventative maintenance benefit is communicated in written form to all patients or covered persons.
   4.  Annual preventative maintenance shall be scheduled by the qualified complex rehabilitation technology wheelchair supplier at the request of the patient or covered person, or the patient’s or covered person’s health care professional. If the patient or covered person does not request annual preventative maintenance, the qualified supplier shall contact the patient or covered person and schedule preventative maintenance at a time that is mutually convenient for both parties. Annual preventative maintenance may also be performed during the provision of service and repairs under section 514M.2.
   5.  Annual preventative maintenance may be performed at the qualified supplier’s facility, or at a wheelchair clinic or other health care facility.
   6.  A third-party payor shall not require any of the following in order for a qualified complex rehabilitation technology wheelchair supplier to perform annual preventative maintenance under this section:
   a.  Prior authorization.
   b.  Documentation of continued medical necessity.
   7.  Documentation of all preventative maintenance performed by a qualified complex rehabilitation technology wheelchair supplier pursuant to this section shall be maintained by the qualified supplier. The documentation shall not be subject to audit by a third-party payor.
    Sec. 4.  NEW SECTION.  514M.4  Third-party payors —— applicability.
   1.  This chapter applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024:
   a.  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   b.  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   c.  An individual or group health maintenance organization contract regulated under chapter 514B.
   d.  A plan established for public employees pursuant to chapter 509A.
   e.  The medical assistance program under chapter 249A including all managed care organizations acting pursuant to a contract with the department of health and human services to administer the medical assistance program.
   2.  This chapter shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
    Sec. 5.  NEW SECTION.  514M.5  Task force —— reimbursement rates.
   1.  The division and the department shall form a task force whose members shall include the commissioner or the commissioner’s designee, the director or the director’s designee, two representatives from Iowa-based qualified complex rehabilitation technology wheelchair suppliers, two Iowa-based qualified complex rehabilitation technology professionals, two patients or the patients’ representatives, two covered persons or the covered person’s representative, and two representatives of third-party payors. All members of the task force shall be reimbursed for all actual and necessary expenses incurred in the performance of duties as a member of the task force.
   2.  The task force shall annually review and determine all of the following:
   a.  The reimbursement rate for service and repairs completed under section 514M.2. The reimbursement rate shall include all related diagnostic and evaluation time, related labor, necessary parts, and reasonable travel time.
   b.  The reimbursement rate for preventative maintenance completed under section 514M.3. The reimbursement rate shall include all related diagnostic and evaluation time, related labor, necessary parts, and reasonable travel time.
   c.  The scope of the preventative maintenance required under section 514M.3.
    Sec. 6.  NEW SECTION.  514M.6  Rules.
   The division and the department shall adopt joint rules pursuant to chapter 17A as necessary to administer this chapter.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs.
   Beginning January 1, 2024, the bill requires a qualified complex rehabilitation technology wheelchair supplier (qualified supplier) that provides a complex rehabilitation technology wheelchair (wheelchair) to a patient or a covered person to provide service and repairs on the wheelchair as requested by the patient or covered person, or the patient’s or covered person’s prescribing health care professional, except in the circumstances detailed in the bill. “Qualified supplier”, “patient”, “covered person”, and “complex rehabilitation technology wheelchair” are defined in the bill.
   The bill prohibits a third-party payor from requiring prior authorization or documentation of continued medical necessity in order for a qualified supplier to provide service and repairs under the bill. “Third-party payor” is defined in the bill.
   Documentation of all service and repairs completed by a qualified supplier under the bill shall be maintained by the qualified supplier, and are not subject to audit by a third-party payor.
   Beginning July 1, 2024, a qualified supplier that provides a wheelchair to a patient shall be required to offer annual preventative maintenance (PM) on the wheelchair, except in the circumstances detailed in the bill. The bill requires that all PM be performed by a qualified technician who is an employee of the qualified supplier. All third-party payors shall ensure that the annual PM benefit is communicated in written form to all patients.
   The PM must be scheduled, and performed in a location, as detailed in the bill. A third-party payor shall not require prior authorization or documentation of continued medical necessity in order for a qualified supplier to perform annual PM. Documentation of all PM shall be maintained by the qualified supplier and shall not be subject to audit by a third-party payor.
   The bill applies to third-party payment providers enumerated in the bill, including the medical assistance program (program) under Code chapter 249A and managed care organizations acting pursuant to a contract with the department of health and human services (HHS) to administer the program. The bill specifies the types of specialized health-related insurance which are not subject to the bill.
   The bill requires the division of insurance (division) and HHS to form a task force made up of members as detailed in the bill. All members of the task force shall be reimbursed for all actual and necessary expenses incurred in the performance of duties as a member of the task force. The task force shall annually review and determine the reimbursement rate (rate) for service and repairs completed under the bill, and the rate shall include all related evaluation and diagnostic time, related labor, necessary parts, and reasonable travel time; the rate for PM completed under the bill, and the rate shall include all related evaluation and diagnostic time, related labor, necessary parts, and reasonable travel time; and the scope of the PM required under the bill.
   The division and HHS shall adopt joint rules as necessary to administer the bill.