Iowa-2023-HF2196-Introduced

H.F. 2196 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 35 -1- LSB 5575YH (3) 90 nls/ko 1/ 7

H.F. 2196 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. 35 -2- LSB 5575YH (3) 90 nls/ko 2/ 7

H.F. 2196 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 35 -3- LSB 5575YH (3) 90 nls/ko 3/ 7

H.F. 2196 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 35 -4- LSB 5575YH (3) 90 nls/ko 4/ 7

H.F. 2196 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 35 -5- LSB 5575YH (3) 90 nls/ko 5/ 7

H.F. 2196 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 35 -6- LSB 5575YH (3) 90 nls/ko 6/ 7

H.F. 2196 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. 24 -7- LSB 5575YH (3) 90 nls/ko 7/ 7