Relating to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs

This bill relates to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs. Beginning January 1, 2025, the bill requires a qualified complex rehabilitation technology wheelchair supplier (qualified supplier) that provides a complex rehabilitation technology wheelchair (wheelchair) to a consumer to provide service and repairs on the wheelchair as requested by the consumer, or the consumer’s prescribing health care professional, except in the circumstances detailed in the bill. “Qualified supplier”, “consumer”, 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. Beginning July 1, 2025, a qualified supplier that provides a wheelchair to a consumer may offer annual preventative maintenance (PM) on the wheelchair, in accordance with manufacturer guidelines. 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. 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 coverage and reimbursement for service and repairs completed under the bill, and the rates shall include all related evaluation and diagnostic time, labor, necessary parts, and reasonable travel time. The division and HHS shall adopt joint rules as necessary to administer the bill.