us-wi/statute/49.45/9r — Complex rehabilitation technology.

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us-wi/statute/49.45/9r — Complex rehabilitation technology. · Axiom

(a)#

In this subsection: 1. “Complex needs patient” means an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation. 2. “Complex rehabilitation technology” means items classified within Medicare as durable medical equipment that are individually configured for individuals to meet their 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. “Complex rehabilitation technology” includes complex rehabilitation manual and power wheelchairs, adaptive seating and positioning items, and other specialized equipment such as standing frames and gait trainers, power seat elevation or power standing components of power wheelchairs, as well as options and accessories related to any of these items. 3. “Individually configured” means having a combination of sizes, features, adjustments, or modifications that a qualified complex rehabilitation technology supplier can customize to the specific individual by measuring, fitting, programming, adjusting, or adapting as appropriate so that the device operates in accordance with an assessment or evaluation of the individual by a qualified health care professional and is consistent with the individual’s medical condition, physical and functional needs and capacities, body size, period of need, and intended use. 4. “Medicare” means coverage under Part A or Part B of Title XVIII of the federal social security act, 42 USC 1395 et seq. 5. “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. 6. “Qualified complex rehabilitation technology supplier” means a company or entity that meets all of the following criteria: a. Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology. b. Is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology. c. Requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient. d. Has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells. e. Provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology. 7. “Qualified health care professional” means any of the following: a. A physician licensed under subch. II of ch. 448. b. A physical therapist who is licensed under subch. III of ch. 448 or who holds a compact privilege under subch. XI of ch. 448. c. An occupational therapist who is licensed under subch. VII of ch. 448 or who holds a compact privilege under subch. XII of ch. 448. d. A chiropractor licensed under ch. 446. e. A physician assistant who is licensed under subch. IX of ch. 448 or who holds a compact privilege under subch. XIII of ch. 448.

(a)(1)#

“Complex needs patient” means an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation.

(a)(2)#

“Complex rehabilitation technology” means items classified within Medicare as durable medical equipment that are individually configured for individuals to meet their 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. “Complex rehabilitation technology” includes complex rehabilitation manual and power wheelchairs, adaptive seating and positioning items, and other specialized equipment such as standing frames and gait trainers, power seat elevation or power standing components of power wheelchairs, as well as options and accessories related to any of these items.

(a)(3)#

“Individually configured” means having a combination of sizes, features, adjustments, or modifications that a qualified complex rehabilitation technology supplier can customize to the specific individual by measuring, fitting, programming, adjusting, or adapting as appropriate so that the device operates in accordance with an assessment or evaluation of the individual by a qualified health care professional and is consistent with the individual’s medical condition, physical and functional needs and capacities, body size, period of need, and intended use.

(a)(4)#

“Medicare” means coverage under Part A or Part B of Title XVIII of the federal social security act, 42 USC 1395 et seq.

(a)(5)#

“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.

(a)(6)#

“Qualified complex rehabilitation technology supplier” means a company or entity that meets all of the following criteria: a. Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology. b. Is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology. c. Requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient. d. Has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells. e. Provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology.

(a)(6)(a)#

Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology.

(a)(6)(b)#

Is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology.

(a)(6)(c)#

Requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient.

(a)(6)(d)#

Has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells.

(a)(6)(e)#

Provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology.

(a)(7)#

“Qualified health care professional” means any of the following: a. A physician licensed under subch. II of ch. 448. b. A physical therapist who is licensed under subch. III of ch. 448 or who holds a compact privilege under subch. XI of ch. 448. c. An occupational therapist who is licensed under subch. VII of ch. 448 or who holds a compact privilege under subch. XII of ch. 448. d. A chiropractor licensed under ch. 446. e. A physician assistant who is licensed under subch. IX of ch. 448 or who holds a compact privilege under subch. XIII of ch. 448.

(a)(7)(a)#

A physician licensed under subch. II of ch. 448.

(a)(7)(b)#

A physical therapist who is licensed under subch. III of ch. 448 or who holds a compact privilege under subch. XI of ch. 448.

(a)(7)(c)#

An occupational therapist who is licensed under subch. VII of ch. 448 or who holds a compact privilege under subch. XII of ch. 448.

(a)(7)(d)#

A chiropractor licensed under ch. 446.

(a)(7)(e)#

A physician assistant who is licensed under subch. IX of ch. 448 or who holds a compact privilege under subch. XIII of ch. 448.

(b)#

The department shall promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. The department shall include in the rules all of the following: 1. Designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes. The department shall include provisions allowing quarterly updates to the designations under this subdivision. 2. Establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers. 3. A requirement that Medical Assistance recipients who need a complex rehabilitation manual wheelchair, complex rehabilitation power wheelchair, or other complex rehabilitation seating component to be evaluated by all of the following: a. A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier. b. A qualified complex rehabilitation technology professional. 4. Establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure, and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients. 5. A requirement for contracts with the department that managed care plans providing services to Medical Assistance recipients comply with this subsection and the rules promulgated under this subsection. 6. Protection of access to complex rehabilitation technology for complex needs patients.

(b)(1)#

Designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes. The department shall include provisions allowing quarterly updates to the designations under this subdivision.

(b)(2)#

Establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers.

(b)(3)#

A requirement that Medical Assistance recipients who need a complex rehabilitation manual wheelchair, complex rehabilitation power wheelchair, or other complex rehabilitation seating component to be evaluated by all of the following: a. A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier. b. A qualified complex rehabilitation technology professional.

(b)(3)(a)#

A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier.

(b)(3)(b)#

A qualified complex rehabilitation technology professional.

(b)(4)#

Establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure, and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients.

(b)(5)#

A requirement for contracts with the department that managed care plans providing services to Medical Assistance recipients comply with this subsection and the rules promulgated under this subsection.

(b)(6)#

Protection of access to complex rehabilitation technology for complex needs patients.

(f)#

1. In this paragraph, “KU modifier” means a modifier used in the federal Medicare program related to an exemption from competitive bidding pricing. 2. For dates of service beginning on March 24, 2024, the department shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Wisconsin under the federal Medicare program, including fees under the KU modifier, if applicable. 3. Beginning July 1, 2025, and annually thereafter, the department shall submit to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2) a report that includes all of the following information: a. The total number of units. b. The total number of claims. c. The total number of claims per provider. d. The average dollar amount of all paid claims. e. The average dollar amount of claims paid per provider. f. The total dollar amount paid per provider. g. A calculation of the amount paid to the provider compared to the amount paid to the provider if the reimbursement were through fee-for-service under the Medical Assistance program under this subchapter. h. The number of repairs done per unit during the last year.

(f)(1)#

In this paragraph, “KU modifier” means a modifier used in the federal Medicare program related to an exemption from competitive bidding pricing.

(f)(2)#

For dates of service beginning on March 24, 2024, the department shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Wisconsin under the federal Medicare program, including fees under the KU modifier, if applicable.

(f)(3)#

Beginning July 1, 2025, and annually thereafter, the department shall submit to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2) a report that includes all of the following information: a. The total number of units. b. The total number of claims. c. The total number of claims per provider. d. The average dollar amount of all paid claims. e. The average dollar amount of claims paid per provider. f. The total dollar amount paid per provider. g. A calculation of the amount paid to the provider compared to the amount paid to the provider if the reimbursement were through fee-for-service under the Medical Assistance program under this subchapter. h. The number of repairs done per unit during the last year.

(f)(3)(a)#

The total number of units.

(f)(3)(b)#

The total number of claims.

(f)(3)(c)#

The total number of claims per provider.

(f)(3)(d)#

The average dollar amount of all paid claims.

(f)(3)(e)#

The average dollar amount of claims paid per provider.

(f)(3)(f)#

The total dollar amount paid per provider.

(f)(3)(g)#

A calculation of the amount paid to the provider compared to the amount paid to the provider if the reimbursement were through fee-for-service under the Medical Assistance program under this subchapter.

(f)(3)(h)#

The number of repairs done per unit during the last year.