S.F. _____ Section 1. COMPLEX REHABILITATION TECHNOLOGY PRODUCTS —— 1 INTENT —— ADOPTION OF RULES. 2 1. It is the intent of the general assembly to do all of the 3 following: 4 a. Provide access for complex needs patients to important 5 technology and supporting services. 6 b. Establish and improve safeguards relating to the 7 delivery and provision of medically necessary complex 8 rehabilitation technology. 9 c. Provide supports for complex needs patients to 10 stay in the home or community-based setting, prevent 11 institutionalization, and prevent hospitalizations and other 12 costly secondary complications. 13 2. The department of human services shall adopt rules 14 pursuant to chapter 17A to provide for the separate 15 recognition and regulation of individually configured, complex 16 rehabilitation technology products and services for complex 17 needs patients under the Medicaid program. The separate 18 recognition under the rules shall: 19 a. Establish separate billing codes for complex 20 rehabilitation technology. 21 b. Take into consideration the customized nature of complex 22 rehabilitation technology and the broad range of services 23 necessary to meet the unique medical and functional needs of 24 people with complex medical needs. 25 c. Establish standards for the purchase of complex 26 rehabilitation technology exclusively from qualified complex 27 rehabilitation technology suppliers. 28 d. Require that complex needs patients receiving complex 29 rehabilitation technology be evaluated by a qualified complex 30 rehabilitation technology professional or a licensed health 31 care provider who has no financial relationship with a 32 qualified complex rehabilitation technology supplier and 33 performs specialty evaluations within the provider’s scope of 34 practice, including a physical therapist licensed under chapter 35 -1- LSB 2570XC (5) 86 pf/nh 1/ 4

S.F. _____ 148A or an occupational therapist licensed under chapter 148B. 1 3. As used in this section: 2 a. “Complex needs patient” means an individual with a 3 diagnosis or medical condition that results in significant 4 physical or functional needs and capacities. The 5 classification of an individual as a “complex needs patient” 6 does not negate the requirement that the individual meet 7 medical necessity requirements under the Medicaid program to 8 qualify for receiving complex rehabilitation technology. 9 b. “Complex rehabilitation technology” means a wheelchair 10 or seating system classified as durable medical equipment 11 within the Medicare program as of January 1, 2013, that meets 12 all of the following criteria: 13 (1) Is individually configured for an individual to meet 14 the individual’s specific and unique medical, physical, 15 and functional needs and capacities for basic activities of 16 daily living and instrumental activities of daily living 17 identified as medically necessary to prevent hospitalization or 18 institutionalization of a complex needs patient. 19 (2) Is primarily used to serve a medical purpose and 20 generally not useful to a person in the absence of an illness 21 or injury. 22 (3) Requires certain services to allow for appropriate 23 design, configuration, and use of such item, including patient 24 evaluation and equipment fitting and configuration. 25 c. “Individually configured” means a device has a 26 combination of features, adjustments, or modifications 27 specific to a complex needs patient that a qualified complex 28 rehabilitation technology supplier provides by measuring, 29 fitting, programming, adjusting, or adapting the device as 30 appropriate so that the device is consistent with an assessment 31 or evaluation of the complex needs patient by a qualified 32 complex rehabilitation technology professional or a health 33 care professional and consistent with the complex needs 34 patient's medical condition, physical and functional needs and 35 -2- LSB 2570XC (5) 86 pf/nh 2/ 4

S.F. _____ capacities, body size, period of need, and intended use. 1 d. “Qualified complex rehabilitation technology supplier” 2 means an entity that meets all of the following criteria: 3 (1) Is accredited by a recognized accrediting organization 4 as a supplier of complex rehabilitation technology. 5 (2) Meets the supplier and quality standards established 6 for durable medical equipment suppliers under the Medicare 7 program. 8 (3) For each site that the supplier operates, employs 9 at least one complex rehabilitation technology professional 10 who has been certified by the rehabilitation engineering and 11 assistive technology society of north America as an assistive 12 technology professional to analyze the needs and capacities of 13 complex needs patients, assist in selecting appropriate covered 14 complex rehabilitation technology items for such needs and 15 capacities, and provide training in the use of the selected 16 covered complex rehabilitation technology items. 17 (4) Has the complex rehabilitation technology professional 18 physically present for the evaluation and determination of the 19 appropriate individually configured complex rehabilitation 20 technologies for the complex needs patient. 21 (5) Provides service and repairs by qualified technicians 22 for all complex rehabilitation technology the supplier sells. 23 (6) Provides written information to the complex needs 24 patient at the time of delivery regarding how the individual 25 may receive services and product repair. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to complex rehabilitation technology 30 products under the Medicaid program. The bill provides the 31 intent of the general assembly and directs the department of 32 human services to adopt rules pursuant to Code chapter 17A 33 to provide for the separate recognition and regulation of 34 individually configured, complex rehabilitation technology 35 -3- LSB 2570XC (5) 86 pf/nh 3/ 4

S.F. _____ products for complex needs patients under the Medicaid program. 1 The separate recognition under the rules is required to 2 establish separate billing codes for complex rehabilitation 3 technology; take into consideration the customized nature 4 of complex rehabilitation technology and the broad range of 5 services necessary to meet the unique medical and functional 6 needs of people with complex medical needs; establish 7 standards for the purchase of complex rehabilitation technology 8 exclusively from qualified complex rehabilitation technology 9 suppliers; and require that complex needs patients receiving 10 complex rehabilitation technology to be evaluated by a 11 qualified complex rehabilitation technology professional or a 12 licensed health care provider. The bill defines “complex needs 13 patient”, “complex rehabilitation technology”, “individually 14 configured”, and “qualified complex rehabilitation technology 15 supplier” for the purposes of the bill. 16 -4- LSB 2570XC (5) 86 pf/nh 4/ 4