Session of 2024
SENATE BILL No. 518
By Committee on Ways and Means
2-15
AN ACT concerning insurance; relating to complex rehabilitation
technology; establishing coverage and reimbursement therefor;
providing for the formation of a complex rehabilitation technology
reimbursement task force; creating the complex rehabilitation
technology coverage act; directing the commissioner of insurance to
adopt rules and regulations.
Be it enacted by the Legislature of the State of Kansas:
Section 1. (a) Sections 1 through 4, and amendments thereto, shall be
known and may be cited as the complex rehabilitation technology
coverage act.
(b) As used in this act:
(1) "Act" means the complex rehabilitation technology coverage act.
(2) "Commissioner" means the commissioner of insurance.
(3) "Complex rehabilitation technology" means items classified
within medicare 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 and instrumental
activities of daily living identified as medically necessary and includes
options and accessories related to such items.
(4) "Complex rehabilitation technology patient" means an individual
with a diagnosis or medical condition that results in significant physical
impairment or functional limitation.
(5) "Department" means the Kansas insurance department.
(6) "Health benefit plan" means the same as defined in K.S.A. 40-
4602, and amendments thereto. "Health benefit plan" includes the Kansas
plan for medical assistance and the state children's insurance plan, as
provided for in K.S.A. 38-2001 et seq., and amendments thereto.
(7) "Health insurer" means the same as defined in K.S.A. 40-4602,
and amendments thereto.
(8) "Individually configured" means having a combination of sizes,
features, adjustments or modifications that a qualified complex
rehabilitation technology supplier can customize to the specific individual
by measuring, fitting, programming, adjusting or adapting as appropriate,
so that the device operates in accordance with an assessment or evaluation
of the individual by a qualified healthcare professional and corresponds to
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the individual's medical condition, physical and functional needs and
capacities, body size, period of need and intended use.
(9) "Qualified complex rehabilitation technology supplier" means a
company or entity that:
(A) Is accredited by a recognized accrediting organization as a
supplier of complex rehabilitation technology;
(B) is an enrolled supplier for purposes of medicare reimbursement
that meets the supplier and quality standards established for durable
medical equipment suppliers, including those for complex rehabilitation
technology under medicare;
(C) is an employer of at least one qualified complex rehabilitation
technology professional to analyze the needs and capacities of the complex
rehabilitation technology patient in consultation with qualified healthcare
professionals, participate in the selection of appropriate complex
rehabilitation technology for such needs and capacities of the complex
rehabilitation technology patient and provide training in the proper use of
the complex rehabilitation technology;
(D) requires a qualified complex rehabilitation technology
professional to be physically present for the evaluation and determination
of appropriate complex rehabilitation technology for a complex
rehabilitation technology patient;
(E) has the capability to provide service and repair by qualified
technicians for all complex rehabilitation technology that it sells; and
(F) provides written information on the complex rehabilitation
technology to the complex rehabilitation technology patient at the time of
delivery, stating how the complex needs patient may receive service and
repair for the complex rehabilitation technology.
(10) "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 and registered with the national registry of
rehabilitation technology suppliers (NRRTS).
(11) "Qualified healthcare professional" means any of the following
authorized prescribers of complex rehabilitation technology:
(A) A person licensed by the state board of healing arts to practice
medicine and surgery or osteopathic medicine and surgery;
(B) a mid-level practitioner as defined in K.S.A. 65-1626, and
amendments thereto;
(C) an occupational therapist licensed to practice occupational
therapy pursuant to the occupational therapy practice act; or
(D) a physical therapist licensed to practice physical therapy pursuant
to the physical therapy practice act.
Sec. 2. (a) Any health insurer that offers a health benefit plan and any
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health benefit plan that offers health insurance coverage for complex
rehabilitation therapy shall:
(1) Not consider the location where the complex rehabilitation
technology will be evaluated or used when making a determination of
medical necessity; and
(2) offer covered persons a prior authorization process that reviews
billable codes and provides coverage determinations for complex
rehabilitation technology.
(b) If a covered individual receives prior authorization stating that the
individual's complex rehabilitation technology will be covered under such
individual's health benefit plan and the individual remains covered under
the policy or contract at the time the complex rehabilitation technology is
delivered to the individual, the health insurer shall:
(1) Pay 100% of the amount approved in the prior authorization,
subject to applicable copayment, coinsurance or deductible requirements
as provided in the policy; and
(2) be prohibited from seeking payment or reimbursement from the
covered person's complex rehabilitation technology supplier or another
party involved with the sale or delivery of the complex rehabilitation
technology.
(c) Any health benefit plan that offers health insurance coverage for
complex rehabilitation technology shall not require a prior authorization or
medical necessity documentation for repairs of such technology or
equipment unless:
(1) The cost of the repairs exceeds the cost to replace the complex
rehabilitation technology; or
(2) the complex rehabilitation technology in need of repair is subject
to replacement because the age of the complex rehabilitation technology
exceeds or is within one year of the expiration of the recommended
lifespan of the complex rehabilitation technology.
(d) No managed care organization shall require a participant in the
Kansas medical assistance program to obtain and submit a prior
authorization or medical necessity documentation for repairing complex
rehabilitation technology unless:
(1) The cost of the repairs exceeds the cost to replace the complex
rehabilitation technology wheelchair; or
(2) the complex rehabilitation technology in need of repair is subject
to replacement because the age of the complex rehabilitation technology or
manual wheelchair exceeds or is within one year of the expiration of the
recommended lifespan of the complex rehabilitation technology.
Sec. 3. (a) Every health insurer and managed care organization
providing state medicaid services under the Kansas program for medical
assistance shall provide coverage and reimbursement for travel time,
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evaluation time and diagnostic time for suppliers of complex rehabilitation
technology for any repairs and replacement of parts on covered complex
rehabilitation technology equipment provided to those covered by the
health insurer or managed care organization.
(b) (1) The department shall appoint a task force to determine an
appropriate rate of reimbursement. The members of the task force shall
include:
(A) The commissioner or the commissioner's designee;
(B) the director or the director's designee;
(C) two representatives from Kansas-based qualified complex
rehabilitation technology suppliers;
(D) two Kansas-based qualified complex rehabilitation technology
professionals;
(E) two patients or the patients' representatives; and
(F) two representatives of third-party payors.
(2) Members of the complex rehabilitation technology task force
attending meetings authorized by the task force shall be paid amounts
provided in K.S.A. 75-3223(e), and amendments thereto, except that task
force members who are employed by a state agency shall be reimbursed by
such state agency.
Sec. 4. (a) A qualified complex rehabilitation technology wheelchair
supplier that provides equipment to a consumer may offer annual
preventative maintenance on the complex rehabilitation technology
wheelchair according to manufacturer guidelines.
(b) All preventative maintenance shall be performed by a qualified
technician who is an employee of the qualified complex rehabilitation
technology supplier.
(c) A health insurer and a managed care organization providing state
medicaid services under the Kansas medicaid assistance program shall
provide coverage and payment for complex rehabilitation technology
preventative maintenance services at least annually, including, but limited
to, labor, parts, diagnostic services, evaluations, travel and other related
costs.
(d) A health insurer and a managed care organization providing state
medicaid services under the Kansas medical assistance program shall
cover and pay for preventative maintenance services without requiring
prior authorization or medical necessity documentation.
(e) Documentation of all preventative maintenance services
performed by a qualified complex rehabilitation technology supplier
pursuant to this section shall be maintained by the qualified supplier.
Sec. 5. This act shall take effect and be in force from and after
January 1, 2025, and its publication in the statute book.
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