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

“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, 2026, 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.