STATEMENT OF SCOPE WISCONSIN DEPARTMENT OF HEALTH SERVICES |
CHAPTER: DHS 101
DHS 105
DHS 107
RELATING TO: Introductions and Definitions
Provider Certification
Covered Services
RULE TYPE: Permanent
SCOPE TYPE: Original
SUMMARY
1.
Description of rule objective/sIn 2017 Wis. Act 306, the Wisconsin Legislature directed the Department to promulgate rules and implement policy to define complex rehabilitation technology, define provider certification for providers, and define under what circumstances complex rehabilitation technology may be covered or reimbursed by Medicaid fee-for-service and managed care organizations. 2.
Existing policies relevant to the ruleDHS 105.40 Durable medical equipment and medical supply vendors
DHS 107.24, Durable Medical Equipment
3.
Policies proposed to be included in the rule
Wisconsin 2017 Act 306 requires the Department to promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. Specific directives and parameters for the rulemaking are stated in the Act. 4.
Analysis of policy alternativeThere are no reasonable alternatives to the proposed rulemaking. The Legislature has explicitly directed the department to submit the proposed rules to the legislative council staff no later than the first day of the 13th month beginning after the effective date of Section 3. of the Act.
5.
Statutory authority for the rulea.
Explanation of authority to promulgate the proposed ruleThe Department’s authority to promulgate the proposed rules is provided in s. 49.45 (9r) (b), Stats., and in 2017 Wis. Act. 306, Section 3. b.
Statute/s that authorize/s the promulgation of the proposed rule(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.
2017 Wis. Act. 306, Section 3., states:
Section 3 . Nonstatutory provisions.
(1) (a ) The department of health services shall submit in proposed form the rules required under section 49.45 (9r) of the statutes, including the rules described under paragraph (b), to the legislative council staff under section 227.15 (1) of the statutes no later than the first day of the 13th month beginning after the effective date of this paragraph. (b) The department of health services shall include in the proposed rules submitted under paragraph (a ) rules that designate the healthcare common procedure coding system codes that are used in the federal Medicare program for complex rehabilitation technology for the Medical Assistance program and are in accordance with section 49.45 (9r) of the statutes. (c) The department shall in the proposed rules exempt the codes designated from any bidding or selective contracting requirements.
c.
Statute/s or rule/s that will affect the proposed rule or be affected by it
6.
Estimates of the amount of time that state employees will spend to develop the rule and other necessary resources
The estimated time for state employees to develop the rule is 2,080 hours.
7.
Description of all of the entities that may be affected by the rule, including any local governmental units, businesses, economic sectors, or public utility ratepayers who may reasonably be anticipated to be affected by the rule
Members across the lifespan who access complex rehabilitation technology
Durable medical equipment dealers who do not meet the provider certification criteria in the law, but currently dispense complex rehabilitation technology
Home health agencies and pharmacies that currently dispense complex rehabilitation technology
Occupational therapists
Boarder state providers. (No border state has a complex rehabilitation technology benefit.)
