Bill Text: IA HF2196 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2024-02-05 - Subcommittee recommends passage. Vote Total: 3-0. [HF2196 Detail]
Download: Iowa-2023-HF2196-Introduced.html
House
File
2196
-
Introduced
HOUSE
FILE
2196
BY
BEST
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
the
maintenance
and
1
repair
of
complex
rehabilitation
technology
wheelchairs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
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Section
1.
NEW
SECTION
.
514M.1
Definitions.
1
For
purposes
of
this
chapter,
unless
the
context
otherwise
2
requires:
3
1.
“Commissioner”
means
the
commissioner
of
insurance.
4
2.
“Complex
rehabilitation
technology
wheelchair”
means
5
a
complex
rehabilitation
manual
or
power
wheelchair
that
is
6
individually
configured
for
a
consumer
to
meet
the
consumer’s
7
specific
and
unique
medical,
physical,
and
functional
needs
8
and
capacities
for
basic
activities
of
daily
living
and
9
instrumental
activities
of
daily
living
identified
as
medically
10
necessary,
and
includes
the
options
and
accessories
related
to
11
the
complex
rehabilitation
manual
or
power
wheelchair.
12
3.
“Consumer”
means
a
covered
person
or
a
patient
who
uses
a
13
complex
rehabilitation
technology
wheelchair.
14
4.
“Covered
person”
means
a
policyholder,
subscriber,
or
15
other
person
participating
in
a
policy,
contract,
or
plan
that
16
provides
for
third-party
payment
or
prepayment
of
health
or
17
medical
expenses.
18
5.
“Department”
means
the
department
of
health
and
human
19
services.
20
6.
“Health
care
professional”
means
the
same
as
defined
in
21
section
514J.102.
22
7.
“Health
carrier”
means
an
entity
subject
to
the
23
insurance
laws
and
regulations
of
this
state,
or
subject
24
to
the
jurisdiction
of
the
commissioner,
including
an
25
insurance
company
offering
sickness
and
accident
plans,
a
26
health
maintenance
organization,
a
nonprofit
health
service
27
corporation,
a
plan
established
pursuant
to
chapter
509A
28
for
public
employees,
or
any
other
entity
providing
a
plan
29
of
health
insurance,
health
care
benefits,
or
health
care
30
services.
31
8.
“Medical
assistance”
means
the
same
as
defined
in
section
32
249A.2.
33
9.
“Patient”
means
an
individual
who
resides
in
the
34
state,
who
is
a
recipient,
and
who
has
a
diagnosis
or
medical
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condition
that
results
in
significant
physical
impairment
or
1
functional
limitation.
2
10.
“Preventative
maintenance”
means
the
regular
and
3
routine
maintenance
of
a
complex
rehabilitation
technology
4
wheelchair,
as
described
in
the
owner’s
manual,
to
ensure
the
5
complex
rehabilitation
technology
wheelchair
maintains
its
6
original
design
quality,
function,
and
utility.
“Preventative
7
maintenance”
may
include
but
is
not
limited
to:
8
a.
An
assessment
and
evaluation
of
the
working
condition
of
9
the
complex
rehabilitation
technology
wheelchair.
10
b.
Any
necessary
adjustment
or
repairs,
including
necessary
11
replacement
parts,
to
the
complex
rehabilitation
technology
12
wheelchair.
13
11.
“Qualified
complex
rehabilitation
technology
14
professional”
means
an
individual
who
is
certified
as
an
15
assistive
technology
professional
by
the
rehabilitation
16
engineering
and
assistive
technology
society
of
North
America.
17
12.
“Qualified
complex
rehabilitation
technology
wheelchair
18
supplier”
or
“qualified
supplier”
means
an
entity
that
meets
all
19
of
the
following
criteria:
20
a.
The
entity
is
accredited
by
a
recognized
accrediting
21
organization
as
a
supplier
of
complex
rehabilitation
technology
22
wheelchairs.
23
b.
The
entity
employs
at
least
one
qualified
complex
24
rehabilitation
technology
professional
to
analyze
the
needs
and
25
capacities
of
a
consumer
in
consultation
with
the
consumer’s
26
prescribing
health
care
professional,
to
participate
in
the
27
selection
of
an
appropriate
complex
rehabilitation
technology
28
wheelchair
for
the
needs
and
capacities
of
the
consumer,
29
and
to
provide
training
in
the
proper
use
of
the
complex
30
rehabilitation
technology
wheelchair.
31
c.
The
entity
has
the
capability
to
provide
service
and
32
repairs,
performed
by
trained
technicians,
for
all
complex
33
rehabilitation
technology
wheelchairs
sold
by
the
qualified
34
supplier.
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d.
At
the
time
of
delivery
of
a
complex
rehabilitation
1
technology
wheelchair
to
a
consumer,
the
entity
provides
2
written
information
that
explains
how
the
consumer
may
receive
3
service,
repairs,
and
annual
preventative
maintenance
for
the
4
complex
rehabilitation
technology
wheelchair.
5
13.
“Recipient”
means
a
person
who
receives
medical
6
assistance
under
chapter
249A.
7
14.
“Third-party
payor”
means
health
carriers
and
8
other
entities
that
provide,
administer,
or
perform
prior
9
authorization
or
claims
processing
for
a
plan
of
health
10
insurance
or
health
care
benefits.
11
Sec.
2.
NEW
SECTION
.
514M.2
Complex
rehabilitation
12
technology
wheelchairs
——
service
and
repairs.
13
1.
Beginning
January
1,
2025,
a
qualified
complex
14
rehabilitation
technology
wheelchair
supplier
that
provides
15
a
complex
rehabilitation
technology
wheelchair
to
a
consumer
16
shall
be
required
to
provide
service
and
repairs
of
the
17
complex
rehabilitation
technology
wheelchair
as
requested
18
by
the
consumer,
or
the
consumer’s
prescribing
health
care
19
professional,
in
accordance
with
the
consumer’s
health
20
carrier
coverage
and
payment
policies,
except
in
the
following
21
circumstances:
22
a.
The
consumer
moves
out
of
the
service
area
after
23
receiving
the
complex
rehabilitation
technology
wheelchair.
24
b.
The
consumer
presents
a
safety
risk
to
the
qualified
25
supplier.
26
2.
A
third-party
payor
shall
not
require
any
of
the
27
following
in
order
for
a
qualified
complex
rehabilitation
28
technology
wheelchair
supplier
to
provide
service
and
repairs
29
under
this
section:
30
a.
Prior
authorization.
31
b.
Documentation
of
continued
medical
necessity
by
a
health
32
care
professional.
33
3.
Documentation
of
all
service
and
repairs
completed
by
a
34
qualified
complex
rehabilitation
technology
wheelchair
supplier
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under
this
section
shall
be
maintained
by
the
qualified
1
supplier.
2
Sec.
3.
NEW
SECTION
.
514M.3
Complex
rehabilitation
3
technology
wheelchairs
——
annual
preventative
maintenance.
4
1.
Beginning
July
1,
2025,
a
qualified
complex
5
rehabilitation
technology
wheelchair
supplier
that
provides
6
a
complex
rehabilitation
technology
wheelchair
to
a
consumer
7
may
offer
annual
preventative
maintenance
on
the
complex
8
rehabilitation
technology
wheelchair
in
accordance
with
9
manufacturer
guidelines.
10
2.
At
a
minimum,
a
third-party
payor
shall
provide
coverage
11
and
payment
for
complex
rehabilitation
technology
wheelchair
12
preventative
maintenance
services
on
an
annual
basis,
including
13
any
labor,
part,
diagnostic
evaluation,
travel,
or
other
14
related
costs.
15
3.
A
third-party
payor
shall
not
require
prior
16
authorization
or
medical
necessity
documentation
to
cover
the
17
cost
of
preventative
maintenance
services
for
a
consumer’s
18
complex
rehabilitation
technology
wheelchair.
19
4.
Documentation
of
all
preventative
maintenance
services
20
performed
by
a
qualified
complex
rehabilitation
technology
21
wheelchair
supplier
pursuant
to
this
section
shall
be
22
maintained
by
the
qualified
supplier.
23
5.
All
preventative
maintenance
shall
be
performed
by
a
24
trained
technician
who
is
an
employee
of
the
qualified
complex
25
rehabilitation
technology
wheelchair
supplier.
26
Sec.
4.
NEW
SECTION
.
514M.4
Third-party
payors
——
27
applicability.
28
1.
This
chapter
applies
to
the
following
classes
of
29
third-party
payor
contracts,
policies,
or
plans
delivered,
30
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
31
after
January
1,
2025:
32
a.
Individual
or
group
accident
and
sickness
insurance
33
providing
coverage
on
an
expense-incurred
basis.
34
b.
An
individual
or
group
hospital
or
medical
service
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contract
issued
pursuant
to
chapter
509,
514,
or
514A.
1
c.
An
individual
or
group
health
maintenance
organization
2
contract
regulated
under
chapter
514B.
3
d.
A
plan
established
for
public
employees
pursuant
to
4
chapter
509A.
5
e.
The
medical
assistance
program
under
chapter
249A
6
including
all
managed
care
organizations
acting
pursuant
to
a
7
contract
with
the
department
of
health
and
human
services
to
8
administer
the
medical
assistance
program.
9
2.
This
chapter
shall
not
apply
to
accident-only,
10
specified
disease,
short-term
hospital
or
medical,
hospital
11
confinement
indemnity,
credit,
dental,
vision,
Medicare
12
supplement,
long-term
care,
basic
hospital
and
medical-surgical
13
expense
coverage
as
defined
by
the
commissioner,
disability
14
income
insurance
coverage,
coverage
issued
as
a
supplement
15
to
liability
insurance,
workers’
compensation
or
similar
16
insurance,
or
automobile
medical
payment
insurance.
17
Sec.
5.
NEW
SECTION
.
514M.5
Task
force
——
reimbursement
18
rates.
19
1.
The
division
and
the
department
shall
form
a
task
20
force
whose
members
shall
include
the
commissioner
or
the
21
commissioner’s
designee,
the
director
or
the
director’s
22
designee,
two
representatives
from
qualified
complex
23
rehabilitation
technology
wheelchair
suppliers,
two
24
representatives
from
rehabilitation
technology
wheelchair
25
manufacturers,
two
consumers
or
the
consumers’
legal
26
representatives,
and
two
representatives
from
third-party
27
payors.
All
members
of
the
task
force
shall
be
reimbursed
for
28
all
actual
and
necessary
expenses
incurred
in
the
performance
29
of
duties
as
a
member
of
the
task
force.
30
2.
The
task
force
shall
annually
review
and
determine
all
31
of
the
following:
32
a.
The
coverage
and
reimbursement
of
service
and
repairs
33
under
section
514M.2.
The
coverage
and
reimbursement
shall
34
include
all
related
diagnostic
and
evaluation
time,
related
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labor,
necessary
parts,
and
reasonable
travel
time.
1
b.
The
reimbursement
for
preventative
maintenance
under
2
section
514M.3.
The
reimbursement
shall
include
all
related
3
diagnostic
and
evaluation
time,
related
labor,
necessary
parts,
4
and
reasonable
travel
time.
5
c.
The
scope
of
the
preventative
maintenance
required
under
6
section
514M.3.
7
Sec.
6.
NEW
SECTION
.
514M.6
Rules.
8
The
division
and
the
department
shall
adopt
joint
rules
9
pursuant
to
chapter
17A
as
necessary
to
administer
this
10
chapter.
11
EXPLANATION
12
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
13
the
explanation’s
substance
by
the
members
of
the
general
assembly.
14
This
bill
relates
to
insurance
coverage
for
the
maintenance
15
and
repair
of
complex
rehabilitation
technology
wheelchairs.
16
Beginning
January
1,
2025,
the
bill
requires
a
qualified
17
complex
rehabilitation
technology
wheelchair
supplier
18
(qualified
supplier)
that
provides
a
complex
rehabilitation
19
technology
wheelchair
(wheelchair)
to
a
consumer
to
provide
20
service
and
repairs
on
the
wheelchair
as
requested
by
21
the
consumer,
or
the
consumer’s
prescribing
health
care
22
professional,
except
in
the
circumstances
detailed
in
the
bill.
23
“Qualified
supplier”,
“consumer”,
and
“complex
rehabilitation
24
technology
wheelchair”
are
defined
in
the
bill.
25
The
bill
prohibits
a
third-party
payor
from
requiring
prior
26
authorization
or
documentation
of
continued
medical
necessity
27
in
order
for
a
qualified
supplier
to
provide
service
and
28
repairs
under
the
bill.
“Third-party
payor”
is
defined
in
the
29
bill.
30
Documentation
of
all
service
and
repairs
completed
by
a
31
qualified
supplier
under
the
bill
shall
be
maintained
by
the
32
qualified
supplier.
33
Beginning
July
1,
2025,
a
qualified
supplier
that
provides
34
a
wheelchair
to
a
consumer
may
offer
annual
preventative
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maintenance
(PM)
on
the
wheelchair,
in
accordance
with
1
manufacturer
guidelines.
A
third-party
payor
shall
not
2
require
prior
authorization
or
documentation
of
continued
3
medical
necessity
in
order
for
a
qualified
supplier
to
perform
4
annual
PM.
Documentation
of
all
PM
shall
be
maintained
by
the
5
qualified
supplier.
6
The
bill
applies
to
third-party
payment
providers
enumerated
7
in
the
bill,
including
the
medical
assistance
program
(program)
8
under
Code
chapter
249A
and
managed
care
organizations
acting
9
pursuant
to
a
contract
with
the
department
of
health
and
human
10
services
(HHS)
to
administer
the
program.
The
bill
specifies
11
the
types
of
specialized
health-related
insurance
which
are
not
12
subject
to
the
bill.
13
The
bill
requires
the
division
of
insurance
(division)
and
14
HHS
to
form
a
task
force
made
up
of
members
as
detailed
in
the
15
bill.
All
members
of
the
task
force
shall
be
reimbursed
for
16
all
actual
and
necessary
expenses
incurred
in
the
performance
17
of
duties
as
a
member
of
the
task
force.
The
task
force
shall
18
annually
review
and
determine
the
coverage
and
reimbursement
19
for
service
and
repairs
completed
under
the
bill,
and
the
rates
20
shall
include
all
related
evaluation
and
diagnostic
time,
21
labor,
necessary
parts,
and
reasonable
travel
time.
22
The
division
and
HHS
shall
adopt
joint
rules
as
necessary
to
23
administer
the
bill.
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