HB75INTRODUCED
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HB75
ZU3MKRW-1
By Representative Clarke
RFD: Health
First Read: 04-Feb-25
PFD: 06-Jan-25
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6 ZU3MKRW-1 11/26/2024 JC (L)lg 2024-2846
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PFD: 06-Jan-25
SYNOPSIS:
There are no provisions in existing law
governing the repair of wheelchairs.
This bill would impose a duty on wheelchair
dealers to repair wheelchairs in a timely manner, with
explicit disciplinary authority given to the Board of
Home Medical Equipment for repeated failure to do so.
This bill would require Medicaid to cover the
cost of a customized wheelchair when medically
necessary.
This bill would eliminate any requirement for a
new prescription or prior authorization for the repair
of a wheelchair from Medicaid or private health
insurance when the wheelchair is less than seven years
old.
This bill would also require wheelchair dealers
who contract with Medicaid to submit annual reports to
the Medicaid Agency concerning wheelchair repairs.
A BILL
TO BE ENTITLED
AN ACT
Relating to wheelchairs; to add Section 34-14C-3.1 to
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Relating to wheelchairs; to add Section 34-14C-3.1 to
the Code of Alabama 1975, and to amend Section 34-14C-6, Code
of Alabama 1975, to provide the Board of Home Medical
Equipment with authority to discipline licensees who fail to
repair wheelchairs in a timely manner; to provide standards
for timely repair of wheelchairs; to require Medicaid to cover
the cost of customized wheelchairs when medically necessary;
to limit the requirement of prior authorization by Medicaid or
private health insurance for repair of certain wheelchairs;
and to impose a reporting requirement on Medicaid wheelchair
contractors.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Section 34-14C-3.1 is added to the Code of
Alabama 1975, to read as follows:
§34-14C-3.1
(a) For the purposes of this section, the following
terms have the following meanings:
(1) AUTHORIZED WHEELCHAIR DEALER. A home medical
equipment services provider that sells or leases wheelchairs,
including customized wheelchairs.
(2) CONSUMER. The individual who uses a wheelchair,
including a customized wheelchair, in his or her place of
residence, regardless of whether the purchase or lease of the
wheelchair is funded in whole or in part by the consumer or by
private or public health insurance.
(3) CUSTOMIZED WHEELCHAIR. A medically necessary manual
or motorized wheelchair that is individually configured for
the consumer with specialized equipment that requires
evaluation, configuration, fitting, adjustment, programming,
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evaluation, configuration, fitting, adjustment, programming,
and long-term maintenance and repair services.
(4) TIMELY REPAIR. No later than 10 business days after
the date of request for repair is received from a consumer,
unless any of the following apply:
a. The consumer fails to make the wheelchair available
for repair.
b. Prior authorization required from private or public
health insurance is not received.
c. Parts necessary for repair of the wheelchair have
not been received.
(5) WHEELCHAIR. A manual or motorized wheeled device,
including a customized wheelchair, that enhances the mobility
or positioning of a consumer.
(b)(1) An authorized wheelchair dealer who sells or
leases a wheelchair, including a customized wheelchair, shall
make timely repair of the wheelchair.
(2) Upon request, an authorized wheelchair dealer who
sells or leases a customized wheelchair shall make timely
repair of the wheelchair at the consumer's residence if it is
reasonable under the circumstances.
(3) An authorized wheelchair dealer shall do all of the
following:
a. Maintain and advertise an electronic mail address
and a phone number so that a consumer may request a repair.
b. Respond to a request for wheelchair repair no later
than one business day after the date of the request.
c. Order parts for a repair no later than three
business days after assessing the need for the repair or after
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business days after assessing the need for the repair or after
receiving prior authorization from private or publicly funded
health insurance.
(c)(1) On and after October 1, 2025, the board shall
conspicuously post on its website an electronic mail address
and phone number to receive complaints regarding timely repair
issues.
(2) Upon receiving a complaint pursuant to this
section, the board may inspect any authorized wheelchair
dealer for cause pursuant to Section 34-14C-4.
Section 2. Section 34-14C-6, Code of Alabama 1975, is
amended to read as follows:
"§34-14C-6
(a) The board may deny, suspend, or revoke a license as
provided in this section.
(b) A license may not be denied, suspended, or revoked
except by majority vote of the board and with prior notice and
opportunity for hearing in accordance with this chapter and
the Alabama Administrative Procedure Act.
(c) The board may institute a hearing for denial,
suspension, or revocation of a license , or any person may file
a written complaint with the board seeking the denial,
suspension, or revocation of an application for licensure or
license issued by the board or the investigation of any
unlicensed person or entity providing home medical equipment
services. The complaint shall be in a form prescribed by the
board.
(d) A copy of the charges, including notice of the time
and place of hearing, shall be served by certified mail,
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and place of hearing, shall be served by certified mail,
return receipt requested, at least 21 days before the
scheduled hearing date to the most recent address of the
applicant or licensee on file with the board, or to the last
known address of any unlicensed person or entity providing
home medical equipment services. If the notice and opportunity
for hearing is refused or the return receipt has not been
received by the board within 10 days before the scheduled
hearing, the applicant, licensee, or unlicensed person or
entity may be served by mailing the charges and notice by
first class mail, at least seven days before the hearing date,
to the most recent address on file with the board, or to the
last known address of the unlicensed person or entity
providing home medical equipment services.
(e) The board may invoke disciplinary action as
outlined in subsection (f) whenever it is established to the
satisfaction of the board, after a hearing held in accordance
with this chapter and the Alabama Administrative Procedure
Act, that any person is guilty of any of the following acts:
(1) Violation of this chapter or a rule of the board.
(2) Making a material misrepresentation in furnishing
information to the board.
(3) Making a misrepresentation to obtain licensure or
to otherwise violate this chapter.
(4) Conviction of or entry of a plea of guilty or nolo
contendere to any crime that is a felony under the laws of the
United States, or any state or territory of the United States,
or to any crime that is a misdemeanor, if an essential element
of the crime is dishonesty or is directly related to providing
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of the crime is dishonesty or is directly related to providing
home medical equipment services.
(5) Gross negligence or gross misconduct in providing
home medical equipment services.
(6) Aiding, assisting, or willingly permitting another
person to violate any provision of this chapter or rule of the
board.
(7) Failing, within 30 days, to provide information in
response to a written request of the board.
(8) Failing to cooperate with an inspection or with an
investigation conducted by the board.
(9) Engaging in dishonorable, unethical, or
unprofessional conduct of a character likely to deceive,
defraud, or harm the public.
(10) Denial, revocation, suspension, or restriction of
a license in another state or jurisdiction to provide home
medical equipment services for a reason other than failure to
renew the license.
(11) Directly or indirectly giving to or receiving from
any person, partnership, corporation, or other legal entity
any fee, commission, rebate, or other form of compensation for
services not actually or personally rendered.
(12) A finding that a licensee on probationary status
has violated the terms of the probation.
(13) Willfully making or filing false records, reports,
or billings in the course of providing home medical equipment
services including, but not limited to, false records,
reports, or billings filed with state or federal agencies or
departments.
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departments.
(14) The use of any words, abbreviations, figures, or
letters with the intention of indicating practice as a home
medical equipment services provider without having first
obtained a license from the board.
(15) Failure to comply with state or federal laws and
regulations concerning home medical equipment services
providers.
(16) Solicitation of home medical equipment services
using false or misleading advertising.
(17) Failure to display a license in accordance with
this chapter.
(18) Failure to report a change of name, address,
control, ownership, or administration to the board within 30
days after the date of change.
(19) Repeated failure to make timely repair of a
wheelchair as provided in Section 34-14C-3.1.
(f) When the board finds any person guilty of any of
the grounds set forth in subsection (e), the board may enter
an order imposing one or more of the following penalties:
(l) A letter of reprimand.
(2) Imposition of probation for a period of time and
subject to such conditions as may be prescribed by the board.
(3) Denial of an application for an initial or renewal
license.
(4) Suspension of a license for a period of time
established by the board, with or without automatic
reinstatement.
(5) Revocation of a license.
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(5) Revocation of a license.
(6) Payment of restitution to each consumer negatively
affected by the prohibited act. Proof of such restitution
shall be a signed and notarized release executed by the
consumer or the estate of the consumer.
(7) Assessment of the costs of the disciplinary
proceedings.
(g) Failure to comply with any final order of the board
is also cause for suspension or revocation of a license. The
board may suspend or revoke any license which has been issued
based on false or fraudulent representations.
(h) The board may informally resolve any alleged
violation of this chapter or rule of the board by stipulation,
agreed settlement, or consent order, in lieu of an
administrative hearing.
(i) Any entity or person found to be providing home
medical equipment services without a license as required by
this chapter shall be subject to an administrative fine of up
to one thousand dollars ($1,000) per day that services were
provided without a license. Funds collected pursuant to this
chapter shall be allocated to the administration of the
program.
(j) Any entity or person found to be providing home
medical equipment services without a license as required by
this chapter may be administratively enjoined by the board
from providing services until such time as the entity or
person complies with this chapter.
(k) In addition to any other disciplinary action
authorized by this chapter, the board may levy and collect
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authorized by this chapter, the board may levy and collect
administrative fines for violations of this chapter or the
rules or standards of the board in an amount of up to one
thousand dollars ($1,000) for each violation.
(l) Any person or entity violating this chapter, upon
conviction, shall be guilty of a Class A misdemeanor, and
subject to fine or imprisonment, or both.
(m) Any entity or person subject to the penalties
prescribed by subsections (i) and (j) may pursue an appeal
through the board according to rules promulgatedadopted by the
board.
(n) Any hearings related to matters before the board
shall be conducted in Montgomery County.
(o) In addition to any other penalty or disciplinary
action authorized by this chapter, the board may seek an
injunction against any person or entity found in violation of
this chapter. In an action for an injunction, the board may
demand and recover a civil penalty of fifty dollars ($50) per
day for each violation, reasonable attorney fees, and court
costs. No civil penalty shall be awarded to the board if an
administrative fine is assessed pursuant to subsection (i).
(p) Upon the revocation or suspension of a license, the
licensee shall immediately surrender the license to the board,
and if the licensee fails to do so, the board may seize the
license.
(q) Any person aggrieved by an adverse action of the
board may appeal the action to the Circuit Court of Montgomery
County in accordance with the Alabama Administrative Procedure
Act."
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Act."
Section 3. (a) As used in this section, the following
words have the following meanings:
(1) AGENCY. The Alabama Medicaid Agency.
(2) AUTHORIZED WHEELCHAIR DEALER. As defined in Section
34-14C-3.1, Code of Alabama 1975.
(3) COMMISSIONER. The Commissioner of the Alabama
Medicaid Agency.
(4) CUSTOMIZED WHEELCHAIR. As defined in Section
34-14C-3.1, Code of Alabama 1975, for a Medicaid recipient
with a disability who is unable to achieve maximum mobility
with a standard wheelchair.
(5) TIMELY REPAIR. As defined in Section 34-14C-3.1,
Code of Alabama 1975.
(6) WHEELCHAIR. As defined in Section 34-14C-3.1, Code
of Alabama 1975.
(b) A customized wheelchair shall be covered under
Medicaid only if it is medically necessary, and a standard
wheelchair does not meet the recipient's needs as determined
by the agency.
(c) The commissioner shall not require a new
prescription or prior authorization for the medically
necessary repair of a customized wheelchair unless the
original prescription or authorization for the customized
wheelchair is more than: (i) five years old in the case of a
Medicaid recipient who is under 21 years of age; or (ii) seven
years old in the case of a Medicaid recipient who is 21 years
of age or older.
(d) No later than September 30, 2026, and annually
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(d) No later than September 30, 2026, and annually
thereafter, an authorized wheelchair dealer that contracts
with the agency to sell or lease wheelchairs to Medicaid
recipients shall submit a report concerning timely repair to
the commissioner that includes for each repair request all of
the following information:
(1) The number of days to initially respond to the
request.
(2) The number of days to conduct a repair assessment.
(3) Whether the repair assessment was made at the
recipient's residence, the repair facility, remotely, or
another location.
(4) If prior authorization to make the repair was
necessary, the number of days to receive the agency
determination.
(5) The number of days from the repair assessment to
order a replacement part.
(6) The number of days from the repair assessment to
complete repair of the wheelchair, including the number of
days to receive any replacement part ordered.
(7) Whether the repair was completed at the recipient's
residence, the repair facility, or another location.
(e) The commissioner shall seek any federal approval
necessary, including amendment of the state Medicaid plan or
application for a waiver, to implement this section.
(f) The commissioner shall adopt any rules or forms to
implement this section.
Section 4. (a) As used in this section, the following
words have the following meanings:
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words have the following meanings:
(1) CUSTOMIZED WHEELCHAIR. As defined in Section
34-14C-3.1, Code of Alabama 1975.
(2) HEALTH BENEFIT PLAN. a. Any plan, policy, or
contract issued, delivered, or renewed in this state that
provides health coverage that includes payment for
hospitalization, physician care, treatment, surgery, therapy,
drugs, equipment, and any other medical expense, regardless of
the following:
1. Whether the plan, policy, or contract is provided by
a health care insurer, health maintenance organization
established under Chapter 21A of Title 27, Code of Alabama
1975, health care services plan established under Chapter 20
of Title 10A, Code of Alabama 1975, or any other entity that
pays for, purchases, or reimburses for health care services.
2. Whether the plan is for a group or an individual.
b. The term does not include accident-only, specified
disease, individual hospital indemnity, credit, dental-only,
Medicare supplement, long-term care, disability income, or
other limited benefit health insurance policies, or coverage
issued as supplemental to liability insurance, workers'
compensation, or automobile medical payment insurance.
(b) Every health benefit plan issued, delivered, or
renewed on and after January 1, 2026, may not require a new
prescription or prior authorization for the medically
necessary repair or replacement of a customized wheelchair
unless the original prescription is more than five years old.
Section 5. This act shall become effective on October
1, 2025.
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