2017 - 2018 LEGISLATURE
SENATE SUBSTITUTE AMENDMENT 1,
TO SENATE BILL 381
October 16, 2017 - Offered by Senator Vukmir.
1An Act to create
49.45 (9r) and 49.46 (2) (b) 6. dm. of the statutes;
2complex rehabilitation technology for complex needs patients in the Medical
3Assistance program and requiring the exercise of rule-making authority.
Analysis by the Legislative Reference Bureau
This substitute amendment requires the Department of Health Services to
establish rules and policies for access to complex rehabilitation technology by
complex needs patients who are recipients of Medical Assistance. Under the
substitute amendment, a “complex needs patient” is an individual with a diagnosis
or medical condition that results in significant physical impairment or functional
limitation, and “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. The substitute amendment specifies that
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, as well as options and
accessories related to any of these items. The substitute amendment provides that,
subject to certain requirements, durable medical equipment that is considered
complex rehabilitation technology, excluding speech generating devices, is a benefit
under the Medical Assistance program.
The substitute amendment requires DHS to include in its rules certain
provisions including 1) designation of billing codes as complex rehabilitation
technology; 2) establishment of specific supplier standards for companies and
entities that provide complex rehabilitation technology and limiting reimbursement
only to suppliers that are qualified complex rehabilitation technology suppliers; 3)
establishment and maintenance of payment rates for complex rehabilitation
technology that are adequate to ensure complex needs patients have access to
complex rehabilitation technology; 4) a requirement for contracts with the
department that managed care plans providing services to Medical Assistance
recipients comply with the rules promulgated by the department; and 5) a
requirement that recipients who need certain complex rehabilitation technology
must be evaluated by a qualified health care professional who does not have a
financial relationship with a qualified supplier and a qualified complex
rehabilitation technology professional, both of which are defined in the substitute
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
49.45 (9r) of the statutes is created to read:
49.45 (9r) Complex rehabilitation technology.
(a) In this subsection:
1. “Complex needs patient" means an individual with a diagnosis or medical 4
condition that results in significant physical impairment or functional limitation.
2. “Complex rehabilitation technology" means items classified within Medicare 6
as durable medical equipment that are individually configured for individuals to 7
meet their specific and unique medical, physical, and functional needs and capacities 8
for basic activities of daily living and instrumental activities of daily living identified 9
as medically necessary. “Complex rehabilitation technology” includes complex 10
rehabilitation manual and power wheelchairs, adaptive seating and positioning 11
items, and other specialized equipment such as standing frames and gait trainers, 12
as well as options and accessories related to any of these items.
3. “Individually configured" means having a combination of sizes, features, 14
adjustments, or modifications that a qualified complex rehabilitation technology
supplier can customize to the specific individual by measuring, fitting, 2
programming, adjusting, or adapting as appropriate so that the device operates in 3
accordance with an assessment or evaluation of the individual by a qualified health 4
care professional and is consistent with the individual's medical condition, physical 5
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 7
federal social security act, 42 USC 1395
5. “Qualified complex rehabilitation technology professional" means an 9
individual who is certified as an assistive technology professional by the 10
Rehabilitation Engineering and Assistive Technology Society of North America.
6. “Qualified complex rehabilitation technology supplier" means a company or 12
entity that meets all of the following criteria:
a. Is accredited by a recognized accrediting organization as a supplier of 14
complex rehabilitation technology.
b. Is an enrolled supplier for purposes of Medicare reimbursement that meets 16
the supplier and quality standards established for durable medical equipment 17
suppliers, including those for complex rehabilitation technology under Medicare.
c. Is an employer of at least one qualified complex rehabilitation technology 19
professional to analyze the needs and capacities of the complex needs patient in 20
consultation with qualified health care professionals, to participate in the selection 21
of appropriate complex rehabilitation technology for those needs and capacities of 22
the complex needs patient, and to provide training in the proper use of the complex 23
d. Requires a qualified complex rehabilitation technology professional to be 2
physically present for the evaluation and determination of appropriate complex 3
rehabilitation technology for a complex needs patient.
e. Has the capability to provide service and repair by qualified technicians for 5
all complex rehabilitation technology it sells.
f. Provides written information at the time of delivery of the complex 7
rehabilitation technology to the complex needs patient stating how the complex 8
needs patient may receive service and repair for the complex rehabilitation 9
7. “Qualified health care professional" means any of the following:
a. A physician or physician assistant licensed under subch. II of ch. 448.
b. A physical therapist licensed under subch. III of ch. 448.
c. An occupational therapist licensed under subch VII of ch. 448.
d. A chiropractor licensed under ch. 446.
(b) The department shall promulgate rules and other policies for use of complex 16
rehabilitation technology by recipients of Medical Assistance. The department shall 17
include in the rules all of the following:
1. Designation of billing codes as complex rehabilitation technology including 19
creation of new billing codes or modification of existing billing codes. The 20
department shall include provisions allowing quarterly updates to the designations 21
under this subdivision.
2. Establishment of specific supplier standards for companies or entities that 23
provide complex rehabilitation technology and limiting reimbursement only to 24
suppliers that are qualified complex rehabilitation technology suppliers.
3. A requirement that Medical Assistance recipients who need a complex 2
rehabilitation manual wheelchair, complex rehabilitation power wheelchair, or 3
other complex rehabilitation seating component to be evaluated by all of the 4
a. A qualified health care professional who does not have a financial 6
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 9
technology that are adequate to ensure complex needs patients have access to 10
complex rehabilitation technology, taking into account the significant resources, 11
infrastructure, and staff needed to appropriately provide complex rehabilitation 12
technology to meet the unique needs of complex needs patients.
5. A requirement for contracts with the department that managed care plans 14
providing services to Medical Assistance recipients comply with this subsection and 15
the rules promulgated under this subsection.
6. Protection of access to complex rehabilitation technology for complex needs 17
(c) This subsection is not intended to affect coverage of speech generating 19
devices, including healthcare common procedure coding system codes E2500, E2502, 20
E2504, E2506, E2508, E2510, E2511, E2512, and E2599, under the Medical 21
49.46 (2) (b) 6. dm. of the statutes is created to read:
(b) 6. dm. Subject to the requirements under s. 49.45 (9r), durable 24
medical equipment that is considered complex rehabilitation technology, excluding 25
speech generating devices.
) The department of health services shall submit in proposed form the 3
rules required under section 49.45 (9r) of the statutes, including the rules described 4
under paragraph (b), to the legislative council staff under section 227.15 (1) of the 5
statutes no later than the first day of the 13th month beginning after the effective 6
date of this paragraph.
(b) The department of health services shall include in the proposed rules 8
submitted under paragraph (a) rules that designate the healthcare common 9
procedure coding system codes that are used in the federal Medicare program for 10
complex rehabilitation technology for the Medical Assistance program and are in 11
accordance with section 49.45 (9r) of the statutes.
(c) The department shall in the proposed rules exempt the codes designated 13
from any bidding or selective contracting requirements.