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REFERENCE TITLE: AHCCCS; complex rehabilitation technology |
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State of Arizona House of Representatives Fifty-sixth Legislature First Regular Session 2023
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HB 2175 |
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Introduced by Representatives Longdon: Schwiebert, Stahl Hamilton, Senator Alston
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An Act
amending title 36, chapter 29, article 1, Arizona Revised Statutes, by adding section 36-2930.07; relating to the Arizona health care cost containment system.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding section 36-2930.07, to read:
36-2930.07. Complex rehabilitation technology; rules; policies; definitions
A. The administration shall establish focused rules and policies for complex rehabilitation technology products and services that consider 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. The rules and policies must do all of the following:
1. Designate specific health care common procedure coding system billing codes as complex rehabilitation technology and, as needed, create new billing codes or modifiers for services and products covered for complex medical needs patients.
2. Establish specific supplier standards for companies or entities that provide complex rehabilitation technology and restrict the provision of complex rehabilitation technology to only qualified complex rehabilitation technology suppliers.
3. Require complex medical needs patients who receive a complex rehabilitation manual wheelchair, power wheelchair or seating component to be evaluated by a qualified health care professional and a qualified complex rehabilitation technology professional.
4. Maintain payment policies and rates for complex rehabilitation technology to ensure that payment amounts are adequate to provide complex medical needs patients with access to those items. Such policies and rates shall take into account the significant resources, infrastructure and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex medical needs patients.
5. Exempt the related complex rehabilitation technology health care common procedure coding system billing codes from inclusion in any bidding, selective contracting or similar initiative.
6. Require that contractors adopt similar policies reflecting the rules and policies prescribed in this section and contract with any willing qualified complex rehabilitation technology supplier.
7. Make any other changes as needed to protect access to complex rehabilitation technology for complex medical needs patients.
B. For the purposes of this section:
1. "Complex medical needs patient":
(a) Means a member with a diagnosis or medical condition that results in a significant physical impairment or functional limitation.
(b) Includes 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, postpolio syndrome, cerebellardegeneration, dystonia, Huntington's disease, spinocerebellar disease and certain types of amputation, paralysis or paresis that result in a significant physical impairment or functional limitation.
2. "Complex rehabilitation technology":
(a) Means items that are classified within the medicare program as of January 1, 2015 as durable medical equipment and 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.
(b) Includes:
(i) Complex rehabilitation manual and power wheelchairs, including options and accessories.
(ii) Adaptive seating and positioning items, including options and accessories.
(iii) Other specialized equipment such as standing frames and gait trainers, including options and accessories.
3. "Health care common procedure coding system" means the billing codes used by medicare and overseen by the centers for medicare and medicaid services that are based on the current procedural technology codes developed by the American medical association.
4. "Individually configured" means a device that has a combination of sizes, features, adjustments or modifications that a qualified complex rehabilitation technology supplier can customize to a specific individual by measuring, fitting, programming, adjusting or adapting the device as appropriate so that the device is consistent with:
(a) An assessment or evaluation of the individual by a qualified health care professional.
(b) The individual's medical condition, physical and functional needs and capacities, body size, period of need and intended use.
5. "Qualified complex rehabilitation technology professional" means an individual who is certified as an assistive technology professional by the rehabilitation engineering and assistive technology society of North America or as a certified complex rehabilitation technology supplier by the national registry of rehabilitation technology suppliers.
6. "Qualified complex rehabilitation technology supplier" means a company or entity that meets all of the following:
(a) Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology.
(b) Is an enrolled medicare supplier and meets the supplier and quality standards established under medicare for durable medical equipment suppliers, including those for complex rehabilitation technology.
(c) Employs at least one qualified complex rehabilitation technology professional for each location to do all of the following:
(i) Analyze the needs and capacities of complex medical needs patients in consultation with qualified heath care professionals.
(ii) Participate in selecting appropriate complex rehabilitation technology for the needs and capacities of complex medical needs patients.
(iii) Provide technology-related training in properly using the complex rehabilitation technology.
(d) Requires a qualified complex rehabilitation technology professional to be physically present for evaluating and determining appropriate complex rehabilitation technology.
(e) Provides service and repair by qualified technicians for all complex rehabilitation technology it sells.
(f) Provides written information at the time of delivering complex rehabilitation technology regarding how the complex medical needs patient may receive service and repair.
7. "Qualified health care professional":
(a) Means a health care professional who is licensed in this state and who has no financial relationship with a qualified complex rehabilitation technology supplier.
(b) Includes a physician who is licensed pursuant to title 32, chapter 13 or 17, a physical therapist who is licensed pursuant to title 32, chapter 19, an occupational therapist who is licensed pursuant to title 32, chapter 34 or any other licensed health care professional who performs specialty evaluations within the professional's scope of practice.