House File 500 - Introduced HOUSE FILE 500 BY BODEN A BILL FOR An Act relating to insurance coverage for the maintenance and 1 repair of complex rehabilitation technology wheelchairs. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2710YH (2) 91 nls/ko
H.F. 500 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 a 5 complex rehabilitation manual or power wheelchair, classified 6 by Medicare as durable medical equipment, that is individually 7 configured for a patient to meet the patients specific and 8 unique medical, physical, and functional needs and capacities 9 for basic activities of daily living and instrumental 10 activities of daily living identified as medically necessary, 11 and includes the options and accessories related to the complex 12 rehabilitation manual or power wheelchair. 13 3. Covered person means a policyholder, subscriber, or 14 other person participating in a policy, contract, or plan that 15 provides for third-party payment or prepayment of health or 16 medical expenses. 17 4. Department means the department of health and human 18 services. 19 5. Health care professional means the same as defined in 20 section 514J.102. 21 6. Health carrier means an entity subject to the 22 insurance laws and regulations of this state, or subject 23 to the jurisdiction of the commissioner, including an 24 insurance company offering sickness and accident plans, a 25 health maintenance organization, a nonprofit health service 26 corporation, a plan established pursuant to chapter 509A 27 for public employees, or any other entity providing a plan 28 of health insurance, health care benefits, or health care 29 services. 30 7. Medical assistance means the same as defined in section 31 249A.2. 32 8. Patient means an individual who resides in the 33 state, who is a recipient, and who has a diagnosis or medical 34 condition that results in significant physical impairment or 35 -1- LSB 2710YH (2) 91 nls/ko 1/ 8
H.F. 500 functional limitation. 1 9. Qualified complex rehabilitation technology professional 2 means an individual who is certified as an assistive technology 3 professional by the rehabilitation engineering and assistive 4 technology society of North America. 5 10. Qualified complex rehabilitation technology wheelchair 6 supplier or qualified supplier means an entity that meets all 7 of the following criteria: 8 a. The entity is accredited by a recognized accrediting 9 organization as a supplier of complex rehabilitation technology 10 wheelchairs. 11 b. The entity employs at least one qualified complex 12 rehabilitation technology professional to analyze the needs and 13 capacities of a patient or a covered person in consultation 14 with the patients or covered persons prescribing health care 15 professional, to participate in the selection of an appropriate 16 complex rehabilitation technology wheelchair for the needs and 17 capacities of the patient or the covered person, and to provide 18 training in the proper use of the complex rehabilitation 19 technology wheelchair. 20 c. The entity requires a qualified complex rehabilitation 21 technology professional to be physically present for the 22 evaluation and determination of an appropriate complex 23 rehabilitation technology wheelchair for a patient or a covered 24 person. 25 d. The entity has the capability to provide service and 26 repairs, performed by qualified technicians, for all complex 27 rehabilitation technology wheelchairs sold by the qualified 28 supplier. 29 e. At the time of delivery of a complex rehabilitation 30 technology wheelchair to a patient or a covered person, the 31 entity provides written information that explains how the 32 patient or covered person may receive service, repairs, and 33 annual preventative maintenance for the complex rehabilitation 34 technology wheelchair. 35 -2- LSB 2710YH (2) 91 nls/ko 2/ 8
H.F. 500 11. Recipient means a person who receives medical 1 assistance under chapter 249A. 2 12. Third-party payor means health carriers and other 3 entities that provide a plan of health insurance or health care 4 benefits. 5 Sec. 2. NEW SECTION . 514M.2 Complex rehabilitation 6 technology wheelchairs service and repairs. 7 1. Beginning January 1, 2026, a qualified complex 8 rehabilitation technology wheelchair supplier that provides a 9 complex rehabilitation technology wheelchair to a patient or 10 to a covered person shall be required to provide service and 11 repairs of the complex rehabilitation technology wheelchair 12 as requested by the patient or the covered person, or the 13 patients or covered persons prescribing health care 14 professional, except in the following circumstances: 15 a. The patient or covered person moves out of state after 16 receiving the complex rehabilitation technology wheelchair. 17 b. The patient or covered person presents a safety risk to 18 any of the qualified suppliers staff members. 19 c. The patient or covered person is no longer a recipient or 20 a covered person. 21 2. A third-party payor shall not require any of the 22 following in order for a qualified complex rehabilitation 23 technology wheelchair supplier to provide service and repairs 24 under this section: 25 a. Prior authorization. 26 b. Documentation of continued medical necessity. 27 3. Documentation of all service and repairs completed by a 28 qualified complex rehabilitation technology wheelchair supplier 29 under this section shall be maintained by the qualified 30 supplier. The documentation shall not be subject to audit by a 31 third-party payor. 32 Sec. 3. NEW SECTION . 514M.3 Complex rehabilitation 33 technology wheelchairs annual preventative maintenance. 34 1. Beginning July 1, 2026, a qualified complex 35 -3- LSB 2710YH (2) 91 nls/ko 3/ 8
H.F. 500 rehabilitation technology wheelchair supplier that provides a 1 complex rehabilitation technology wheelchair to a patient or to 2 a covered person shall be required to offer annual preventative 3 maintenance on the complex rehabilitation technology wheelchair 4 except in the following circumstances: 5 a. The patient or covered person moves out of state after 6 receiving the complex rehabilitation technology wheelchair. 7 b. The patient or covered person presents a safety risk to 8 any of the qualified suppliers staff members. 9 c. The patient or covered person is no longer a recipient or 10 a covered person. 11 2. All preventative maintenance shall be performed by 12 a qualified technician who is an employee of the qualified 13 complex rehabilitation technology wheelchair supplier. 14 3. All third-party payors shall ensure that the annual 15 preventative maintenance benefit is communicated in written 16 form to all patients or covered persons. 17 4. Annual preventative maintenance shall be scheduled by 18 the qualified complex rehabilitation technology wheelchair 19 supplier at the request of the patient or covered person, or 20 the patients or covered persons health care professional. 21 If the patient or covered person does not request annual 22 preventative maintenance, the qualified supplier shall contact 23 the patient or covered person and schedule preventative 24 maintenance at a time that is mutually convenient for both 25 parties. Annual preventative maintenance may also be performed 26 during the provision of service and repairs under section 27 514M.2. 28 5. Annual preventative maintenance may be performed at the 29 qualified suppliers facility, or at a wheelchair clinic or 30 other health care facility. 31 6. A third-party payor shall not require any of the 32 following in order for a qualified complex rehabilitation 33 technology wheelchair supplier to perform annual preventative 34 maintenance under this section: 35 -4- LSB 2710YH (2) 91 nls/ko 4/ 8
H.F. 500 a. Prior authorization. 1 b. Documentation of continued medical necessity. 2 7. Documentation of all preventative maintenance performed 3 by a qualified complex rehabilitation technology wheelchair 4 supplier pursuant to this section shall be maintained by the 5 qualified supplier. The documentation shall not be subject to 6 audit by a third-party payor. 7 Sec. 4. NEW SECTION . 514M.4 Third-party payors 8 applicability. 9 1. This chapter applies to the following classes of 10 third-party payment provider contracts, policies, or plans 11 delivered, issued for delivery, continued, or renewed in this 12 state on or after January 1, 2026: 13 a. Individual or group accident and sickness insurance 14 providing coverage on an expense-incurred basis. 15 b. An individual or group hospital or medical service 16 contract issued pursuant to chapter 509, 514, or 514A. 17 c. An individual or group health maintenance organization 18 contract regulated under chapter 514B. 19 d. A plan established for public employees pursuant to 20 chapter 509A. 21 e. The medical assistance program under chapter 249A 22 including all managed care organizations acting pursuant to a 23 contract with the department of health and human services to 24 administer the medical assistance program. 25 2. This chapter shall not apply to accident-only, 26 specified disease, short-term hospital or medical, hospital 27 confinement indemnity, credit, dental, vision, Medicare 28 supplement, long-term care, basic hospital and medical-surgical 29 expense coverage as defined by the commissioner, disability 30 income insurance coverage, coverage issued as a supplement 31 to liability insurance, workers compensation or similar 32 insurance, or automobile medical payment insurance. 33 Sec. 5. NEW SECTION . 514M.5 Task force reimbursement 34 rates. 35 -5- LSB 2710YH (2) 91 nls/ko 5/ 8
H.F. 500 1. The division and the department shall form a task 1 force whose members shall include the commissioner or the 2 commissioners designee, the director or the directors 3 designee, two representatives from Iowa-based qualified complex 4 rehabilitation technology wheelchair suppliers, two Iowa-based 5 qualified complex rehabilitation technology professionals, two 6 patients or the patients representatives, two covered persons 7 or the covered persons representative, and two representatives 8 of third-party payors. All members of the task force shall be 9 reimbursed for all actual and necessary expenses incurred in 10 the performance of duties as a member of the task force. 11 2. The task force shall annually review and determine all 12 of the following: 13 a. The reimbursement rate for service and repairs completed 14 under section 514M.2. The reimbursement rate shall include 15 all related diagnostic and evaluation time, related labor, 16 necessary parts, and reasonable travel time. 17 b. The reimbursement rate for preventative maintenance 18 completed under section 514M.3. The reimbursement rate shall 19 include all related diagnostic and evaluation time, related 20 labor, necessary parts, and reasonable travel time. 21 c. The scope of the preventative maintenance required under 22 section 514M.3. 23 Sec. 6. NEW SECTION . 514M.6 Rules. 24 The division and the department shall adopt joint rules 25 pursuant to chapter 17A as necessary to administer this 26 chapter. 27 EXPLANATION 28 The inclusion of this explanation does not constitute agreement with 29 the explanations substance by the members of the general assembly. 30 This bill relates to insurance coverage for the maintenance 31 and repair of complex rehabilitation technology wheelchairs. 32 Beginning January 1, 2026, the bill requires a qualified 33 complex rehabilitation technology wheelchair supplier 34 (qualified supplier) that provides a complex rehabilitation 35 -6- LSB 2710YH (2) 91 nls/ko 6/ 8
H.F. 500 technology wheelchair (wheelchair) to a patient or a covered 1 person to provide service and repairs on the wheelchair as 2 requested by the patient or covered person, or the patients 3 or covered persons prescribing health care professional, 4 except in the circumstances detailed in the bill. Qualified 5 supplier, patient, covered person, and complex 6 rehabilitation technology wheelchair are defined in the bill. 7 The bill prohibits a third-party payor from requiring prior 8 authorization or documentation of continued medical necessity 9 in order for a qualified supplier to provide service and 10 repairs under the bill. Third-party payor is defined in the 11 bill. 12 Documentation of all service and repairs completed by a 13 qualified supplier under the bill shall be maintained by 14 the qualified supplier, and are not subject to audit by a 15 third-party payor. 16 Beginning July 1, 2026, a qualified supplier that provides 17 a wheelchair to a patient shall be required to offer annual 18 preventative maintenance (PM) on the wheelchair, except in the 19 circumstances detailed in the bill. The bill requires that all 20 PM be performed by a qualified technician who is an employee of 21 the qualified supplier. All third-party payors shall ensure 22 that the annual PM benefit is communicated in written form to 23 all patients. 24 The PM must be scheduled, and performed in a location, as 25 detailed in the bill. A third-party payor shall not require 26 prior authorization or documentation of continued medical 27 necessity in order for a qualified supplier to perform annual 28 PM. Documentation of all PM shall be maintained by the 29 qualified supplier and shall not be subject to audit by a 30 third-party payor. 31 The bill applies to third-party payment providers enumerated 32 in the bill, including the medical assistance program (program) 33 under Code chapter 249A and managed care organizations acting 34 pursuant to a contract with the department of health and human 35 -7- LSB 2710YH (2) 91 nls/ko 7/ 8
H.F. 500 services (HHS) to administer the program. The bill specifies 1 the types of specialized health-related insurance which are not 2 subject to the bill. 3 The bill requires the division of insurance (division) and 4 HHS to form a task force made up of members as detailed in the 5 bill. All members of the task force shall be reimbursed for 6 all actual and necessary expenses incurred in the performance 7 of duties as a member of the task force. The task force shall 8 annually review and determine the reimbursement rate (rate) 9 for service and repairs completed under the bill, and the rate 10 shall include all related evaluation and diagnostic time, 11 related labor, necessary parts, and reasonable travel time; 12 the rate for PM completed under the bill, and the rate shall 13 include all related evaluation and diagnostic time, related 14 labor, necessary parts, and reasonable travel time; and the 15 scope of the PM required under the bill. 16 The division and HHS shall adopt joint rules as necessary to 17 administer the bill. 18 -8- LSB 2710YH (2) 91 nls/ko 8/ 8