Bill Text: IL HB2502 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Creates the Complex Needs Patient Act. Requires the Department of Healthcare and Family Services to provide separate recognition within the State's Medicaid program for individually configured complex rehabilitation technology products and services for complex needs patients. Defines "complex needs patient" to mean an individual with a diagnosis or medical condition that results in significant physical or functional needs and capacities. Provides that the separate recognition for technology products and services for complex needs patients shall take into consideration the customized nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of people with complex medical needs. Provides that the Department shall require complex needs patients receiving complex rehabilitation technology to be evaluated by a qualified health care professional and a qualified complex rehabilitation technology professional. Amends the Illinois Insurance Code. Provides that a managed care plan amended, delivered, issued, or renewed in this State after the effective date of the amendatory Act shall adopt the regulations and policies outlined in the Complex Needs Patient Act. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Failed) 2014-12-03 - Session Sine Die [HB2502 Detail]

Download: Illinois-2013-HB2502-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB2502 Introduced , by Rep. Esther Golar SYNOPSIS AS INTRODUCED:
New Act
215 ILCS 5/356z.22 new
Creates the Complex Needs Patient Act. Requires the Department of Healthcare and Family Services to provide separate recognition within the State's Medicaid program for individually configured complex rehabilitation technology products and services for complex needs patients. Defines "complex needs patient" to mean an individual with a diagnosis or medical condition that results in significant physical or functional needs and capacities. Provides that the separate recognition for technology products and services for complex needs patients shall take into consideration the customized nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of people with complex medical needs. Provides that the Department shall require complex needs patients receiving complex rehabilitation technology to be evaluated by a qualified health care professional and a qualified complex rehabilitation technology professional. Amends the Illinois Insurance Code. Provides that a managed care plan amended, delivered, issued, or renewed in this State after the effective date of the amendatory Act shall adopt the regulations and policies outlined in the Complex Needs Patient Act. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
Complex Needs Patient Act.
Section 5. Purpose.
It is the intent of the General Assembly to:
(1) protect access for complex needs patients to
important technology and supporting services;
(2) establish and improve safeguards relating to the
delivery and provision of medically necessary complex
rehabilitation technology;
(3) provide supports for complex needs patients to stay
in the home or community setting, prevent
institutionalization, and prevent hospitalizations and
other costly secondary complications; and
(4) establish adequate pricing for complex
rehabilitation technology for the purpose of allowing
continued access to appropriate products and services.
Section 10. Definitions. As used in this Act:
(a) "Complex needs patient" means an individual with a
diagnosis or medical condition that results in significant

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physical or functional needs and capacities. Such term shall
include individuals with progressive or degenerative
neuromuscular diseases or injuries or trauma which resulted in
significant physical or functional needs and capacities,
including, but not limited to, individuals with spinal cord
injury, traumatic brain injury, cerebral palsy, muscular
dystrophy, spina bifida, osteogenesis imperfecta,
arthrogryposis, amyotrophic lateral sclerosis, multiple
sclerosis, demyelinating disease, myelopathy, myopathy,
progressive muscular atrophy, anterior horn cell disease,
post-polio syndrome, cerebellar degeneration, dystonia,
Huntington's disease, spinocerebellar disease, and certain
types of amputation, paralysis, or paresis that result in
significant physical or functional needs and capacities.
(b) "Complex rehabilitation technology" means items
currently classified by the Centers for Medicare and Medicaid
Services as of January 1, 2013 as durable medical equipment
that are individually configured for individuals to meet their
specific and unique medical, physical, and functional needs and
capacities for basic activities of daily living and
instrumental activities of daily living identified as
medically necessary to prevent hospitalization or
institutionalization of a complex needs patient. Such items
shall include, but not be limited to, complex rehabilitation
power wheelchairs, highly configurable manual wheelchairs,
adaptive seating and positioning systems, and other

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specialized equipment such as standing frames and gait
trainers. The related Healthcare Common Procedure Code System
(HCPCS) billing codes include, but are not limited to:
(1) Pure Complex Rehab Technology (CRT) Codes: These
HCPCS codes contain 100% CRT products: E0637, E0638, E0641,
E0642, E0986, E1002, E1003, E1004, E1005, E1006, E1007,
E1008, E1009, E1010, E1011, E1014, E1037, E1161, E1220,
E1228, E1229, E1231, E1232, E1233, E1234, E1235, E1236,
E1237, E1238, E1239, E2209, E2291, E2292, E2293, E2294,
E2295, E2300, E2301, E2310, E2311, E2312, E2313, E2321,
E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329,
E2330, E2331, E2351, E2373, E2374, E2376, E2377, E2609,
E2610, E2617, E8000, E8001, E8002, K0005, K0835, K0836,
K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848,
K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856,
K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864,
K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880,
K0884, K0885, K0886, K0890, K0891, and K0898.
(2) Mixed CRT Codes: These HCPCS codes contain a mix of
CRT products and standard mobility and accessory products:
E0950, E0951, E0952, E0955, E0956, E0957, E0958, E0960,
E0967, E0978, E0990, E1015, E1016, E1028, E1029, E1030,
E2205, E2208, E2231, E2368, E2369, E2370, E2605, E2606,
E2607, E2608, E2613, E2614, E2615, E2616, E2620, E2621,
E2624, E2625, K0004, K0009, K0040, K0108, and K0669.
(3) Future codes created to expand on or replace those

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indicated in paragraphs (1) and (2) of this subsection.
(c) "Individually configured" means a combination of
features, adjustments, or modifications a supplier makes to a
device that are specific to an individual and that the supplier
provides by measuring, fitting, programming, adjusting, or
adapting the device as appropriate so that the device is
consistent with an assessment or evaluation of the individual
by a health care professional and consistent with the
individual's medical condition, physical and functional needs,
capacities, body size, period of need, and intended use.
(d) "Qualified complex rehabilitation technology supplier"
means a company or entity that:
(1) is accredited by a recognized accrediting
organization as a supplier of complex rehabilitation
technology;
(2) is enrolled in the Medicare program and meets
the supplier and quality standards established for
durable medical equipment suppliers under the Medicare
program;
(3) employs at least one complex rehabilitation
technology professional for each location to (i)
analyze the needs and capacities of qualified
individuals with complex medical needs, (ii) assist in
selecting appropriate covered complex rehabilitation
technology items for such needs and capacities, and
(iii) provide training in the use of the selected

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covered complex rehabilitation technology items; the
complex rehabilitation technology professional shall
be certified by the Rehabilitation Engineering and
Assistive Technology Society of North America as an
Assistive Technology Professional (ATP);
(4) has the complex rehabilitation technology
professional physically present for the evaluation and
determination of the appropriate individually
configured complex rehabilitation technologies for the
qualified individual with complex medical needs; and
(5) provides service and repair by qualified
technicians for all complex rehabilitation technology
products it sells.
(e) "Qualified complex rehabilitation technology
professional" means an individual who is certified by the
Rehabilitation Engineering and Assistive Technology Society of
North America as an Assistive Technology Professional (ATP).
Section 15. Creation of a separate recognition for complex
rehabilitation technology.
(a) The Department of Healthcare and Family Services shall
provide a separate recognition within the State's Medicaid
program established under Article V of the Illinois Public Aid
Code for complex rehabilitation technology and shall make other
required changes to protect access to appropriate products and
services. The Department shall provide separate recognition

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for individually configured complex rehabilitation technology
products and services for complex needs patients. Such separate
recognition shall take into consideration the customized
nature of complex rehabilitation technology and the broad range
of services necessary to meet the unique medical and functional
needs of people with complex medical needs by doing all of the
following:
(1) By using as a reference those billing codes listed
under paragraphs (1) and (2) of subsection (b) of Section
10, designating appropriate current billing codes as
complex rehabilitation technology and, as needed, creating
new billing codes for services and products covered for
complex needs patients.
(2) Establishing specific supplier standards for
companies or entities that provide complex rehabilitation
technology and restricting the provision of complex
rehabilitation technology to only those companies or
entities that meet such standards.
(3) Developing pricing policies for complex
rehabilitation technology by doing all of the following:
(A) The billing codes referenced under paragraphs
(1) and (2) of subsection (b) of Section 10 shall
maintain a reimbursement level of no less than 100% of
the current Medicare fee schedule amount minus 6%. If
the item is not covered by Medicare or is individually
considered for reimbursement, then the State's

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Medicaid plan shall adopt an allowable amount at the
Manufacturer's Suggested Retail Price (MSRP) minus
10%.
(B) Adopting the usage of KE billing code modifiers
used to help maintain access to complex rehabilitation
technology products for those patients who require it.
(C) Modifying the prior approval requirement for
wheelchair repairs to apply only when the cost of any
one part is greater than or equal to $500 per line
item, when the sum of the parts is greater than or
equal to a total of $1,500, or when 8 or more units of
labor are to be billed. This change shall allow
Medicaid beneficiaries to retain access to timely
service and repair for routine maintenance while also
allowing for a more thorough State review on higher
dollar claims. Repair requests shall not require the
provider to obtain a physician's prescription. The
only exception to this shall be for modifications,
which are defined as the addition of a part that was
not already on the equipment. Repairs shall also be
priced by the Department at the Medicare fee schedule
amount minus 6% for set rate items and for those
without a Medicare allowable amount at MSRP minus 10%.
The Department shall allow for expedited approval of
repairs that include wheelchair batteries.
Additionally, the Department shall expand its

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expedited approval process to include circumstances in
which the patient's wheelchair will be inoperable
without the needed repair, causing the patient to be
bed-bound or otherwise confined.
(D) Exempting the billing codes referenced in
paragraphs (1) and (2) of subsection (b) of Section 10
from inclusion in any competitive bidding or other such
programs.
(4) Making other changes as needed to protect access to
complex rehabilitation technology for people with complex
medical needs.
(b) The Department of Healthcare and Family Services shall
require complex needs patients receiving complex
rehabilitation technology to be evaluated by:
(1) a qualified health care professional, including,
but not limited to, a physical therapist, occupational
therapist, or other health care professional who performs
specialty evaluations within his or her scope of practice;
and
(2) a qualified complex rehabilitation technology
professional.
Section 20. The Illinois Insurance Code is amended by
adding Section 356z.22 as follows:
(215 ILCS 5/356z.22 new)

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Sec. 356z.22. Coverage for complex rehabilitation
technology products and services for complex needs patients. A
managed care plan amended, delivered, issued, or renewed in
this State after the effective date of this amendatory Act of
the 98th General Assembly shall adopt the regulations and
policies outlined in the Complex Needs Patient Act.
Section 99. Effective date. This Act takes effect upon
becoming law.