KS
Kansas Senate Bill SB518

Kansas 2023-2024 Regular Session

Kansas Senate Bill SB518 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 Session of 2024
22 SENATE BILL No. 518
33 By Committee on Ways and Means
44 2-15
55 AN ACT concerning insurance; relating to complex rehabilitation
66 technology; establishing coverage and reimbursement therefor;
77 providing for the formation of a complex rehabilitation technology
88 reimbursement task force; creating the complex rehabilitation
99 technology coverage act; directing the commissioner of insurance to
1010 adopt rules and regulations.
1111 Be it enacted by the Legislature of the State of Kansas:
1212 Section 1. (a) Sections 1 through 4, and amendments thereto, shall be
1313 known and may be cited as the complex rehabilitation technology
1414 coverage act.
1515 (b) As used in this act:
1616 (1) "Act" means the complex rehabilitation technology coverage act.
1717 (2) "Commissioner" means the commissioner of insurance.
1818 (3) "Complex rehabilitation technology" means items classified
1919 within medicare as durable medical equipment that are individually
2020 configured for individuals to meet their specific and unique medical,
2121 physical and functional needs and capacities for basic and instrumental
2222 activities of daily living identified as medically necessary and includes
2323 options and accessories related to such items.
2424 (4) "Complex rehabilitation technology patient" means an individual
2525 with a diagnosis or medical condition that results in significant physical
2626 impairment or functional limitation.
2727 (5) "Department" means the Kansas insurance department.
2828 (6) "Health benefit plan" means the same as defined in K.S.A. 40-
2929 4602, and amendments thereto. "Health benefit plan" includes the Kansas
3030 plan for medical assistance and the state children's insurance plan, as
3131 provided for in K.S.A. 38-2001 et seq., and amendments thereto.
3232 (7) "Health insurer" means the same as defined in K.S.A. 40-4602,
3333 and amendments thereto.
3434 (8) "Individually configured" means having a combination of sizes,
3535 features, adjustments or modifications that a qualified complex
3636 rehabilitation technology supplier can customize to the specific individual
3737 by measuring, fitting, programming, adjusting or adapting as appropriate,
3838 so that the device operates in accordance with an assessment or evaluation
3939 of the individual by a qualified healthcare professional and corresponds to
4040 1
4141 2
4242 3
4343 4
4444 5
4545 6
4646 7
4747 8
4848 9
4949 10
5050 11
5151 12
5252 13
5353 14
5454 15
5555 16
5656 17
5757 18
5858 19
5959 20
6060 21
6161 22
6262 23
6363 24
6464 25
6565 26
6666 27
6767 28
6868 29
6969 30
7070 31
7171 32
7272 33
7373 34
7474 35
7575 36 SB 518 2
7676 the individual's medical condition, physical and functional needs and
7777 capacities, body size, period of need and intended use.
7878 (9) "Qualified complex rehabilitation technology supplier" means a
7979 company or entity that:
8080 (A) Is accredited by a recognized accrediting organization as a
8181 supplier of complex rehabilitation technology;
8282 (B) is an enrolled supplier for purposes of medicare reimbursement
8383 that meets the supplier and quality standards established for durable
8484 medical equipment suppliers, including those for complex rehabilitation
8585 technology under medicare;
8686 (C) is an employer of at least one qualified complex rehabilitation
8787 technology professional to analyze the needs and capacities of the complex
8888 rehabilitation technology patient in consultation with qualified healthcare
8989 professionals, participate in the selection of appropriate complex
9090 rehabilitation technology for such needs and capacities of the complex
9191 rehabilitation technology patient and provide training in the proper use of
9292 the complex rehabilitation technology;
9393 (D) requires a qualified complex rehabilitation technology
9494 professional to be physically present for the evaluation and determination
9595 of appropriate complex rehabilitation technology for a complex
9696 rehabilitation technology patient;
9797 (E) has the capability to provide service and repair by qualified
9898 technicians for all complex rehabilitation technology that it sells; and
9999 (F)  provides written information on the complex rehabilitation
100100 technology to the complex rehabilitation technology patient at the time of
101101 delivery, stating how the complex needs patient may receive service and
102102 repair for the complex rehabilitation technology.
103103 (10) "Qualified complex rehabilitation technology professional"
104104 means an individual who is certified as an assistive technology
105105 professional by the rehabilitation engineering and assistive technology
106106 society of North America and registered with the national registry of
107107 rehabilitation technology suppliers (NRRTS).
108108 (11) "Qualified healthcare professional" means any of the following
109109 authorized prescribers of complex rehabilitation technology:
110110 (A) A person licensed by the state board of healing arts to practice
111111 medicine and surgery or osteopathic medicine and surgery;
112112 (B) a mid-level practitioner as defined in K.S.A. 65-1626, and
113113 amendments thereto;
114114 (C) an occupational therapist licensed to practice occupational
115115 therapy pursuant to the occupational therapy practice act; or
116116 (D) a physical therapist licensed to practice physical therapy pursuant
117117 to the physical therapy practice act.
118118 Sec. 2. (a) Any health insurer that offers a health benefit plan and any
119119 1
120120 2
121121 3
122122 4
123123 5
124124 6
125125 7
126126 8
127127 9
128128 10
129129 11
130130 12
131131 13
132132 14
133133 15
134134 16
135135 17
136136 18
137137 19
138138 20
139139 21
140140 22
141141 23
142142 24
143143 25
144144 26
145145 27
146146 28
147147 29
148148 30
149149 31
150150 32
151151 33
152152 34
153153 35
154154 36
155155 37
156156 38
157157 39
158158 40
159159 41
160160 42
161161 43 SB 518 3
162162 health benefit plan that offers health insurance coverage for complex
163163 rehabilitation therapy shall:
164164 (1) Not consider the location where the complex rehabilitation
165165 technology will be evaluated or used when making a determination of
166166 medical necessity; and
167167 (2) offer covered persons a prior authorization process that reviews
168168 billable codes and provides coverage determinations for complex
169169 rehabilitation technology.
170170 (b) If a covered individual receives prior authorization stating that the
171171 individual's complex rehabilitation technology will be covered under such
172172 individual's health benefit plan and the individual remains covered under
173173 the policy or contract at the time the complex rehabilitation technology is
174174 delivered to the individual, the health insurer shall:
175175 (1) Pay 100% of the amount approved in the prior authorization,
176176 subject to applicable copayment, coinsurance or deductible requirements
177177 as provided in the policy; and
178178 (2) be prohibited from seeking payment or reimbursement from the
179179 covered person's complex rehabilitation technology supplier or another
180180 party involved with the sale or delivery of the complex rehabilitation
181181 technology.
182182 (c) Any health benefit plan that offers health insurance coverage for
183183 complex rehabilitation technology shall not require a prior authorization or
184184 medical necessity documentation for repairs of such technology or
185185 equipment unless:
186186 (1) The cost of the repairs exceeds the cost to replace the complex
187187 rehabilitation technology; or
188188 (2) the complex rehabilitation technology in need of repair is subject
189189 to replacement because the age of the complex rehabilitation technology
190190 exceeds or is within one year of the expiration of the recommended
191191 lifespan of the complex rehabilitation technology.
192192 (d) No managed care organization shall require a participant in the
193193 Kansas medical assistance program to obtain and submit a prior
194194 authorization or medical necessity documentation for repairing complex
195195 rehabilitation technology unless:
196196 (1) The cost of the repairs exceeds the cost to replace the complex
197197 rehabilitation technology wheelchair; or
198198 (2) the complex rehabilitation technology in need of repair is subject
199199 to replacement because the age of the complex rehabilitation technology or
200200 manual wheelchair exceeds or is within one year of the expiration of the
201201 recommended lifespan of the complex rehabilitation technology.
202202 Sec. 3. (a) Every health insurer and managed care organization
203203 providing state medicaid services under the Kansas program for medical
204204 assistance shall provide coverage and reimbursement for travel time,
205205 1
206206 2
207207 3
208208 4
209209 5
210210 6
211211 7
212212 8
213213 9
214214 10
215215 11
216216 12
217217 13
218218 14
219219 15
220220 16
221221 17
222222 18
223223 19
224224 20
225225 21
226226 22
227227 23
228228 24
229229 25
230230 26
231231 27
232232 28
233233 29
234234 30
235235 31
236236 32
237237 33
238238 34
239239 35
240240 36
241241 37
242242 38
243243 39
244244 40
245245 41
246246 42
247247 43 SB 518 4
248248 evaluation time and diagnostic time for suppliers of complex rehabilitation
249249 technology for any repairs and replacement of parts on covered complex
250250 rehabilitation technology equipment provided to those covered by the
251251 health insurer or managed care organization.
252252 (b) (1) The department shall appoint a task force to determine an
253253 appropriate rate of reimbursement. The members of the task force shall
254254 include:
255255 (A) The commissioner or the commissioner's designee;
256256 (B) the director or the director's designee;
257257 (C) two representatives from Kansas-based qualified complex
258258 rehabilitation technology suppliers;
259259 (D) two Kansas-based qualified complex rehabilitation technology
260260 professionals;
261261 (E) two patients or the patients' representatives; and
262262 (F) two representatives of third-party payors.
263263 (2) Members of the complex rehabilitation technology task force
264264 attending meetings authorized by the task force shall be paid amounts
265265 provided in K.S.A. 75-3223(e), and amendments thereto, except that task
266266 force members who are employed by a state agency shall be reimbursed by
267267 such state agency.
268268 Sec. 4. (a) A qualified complex rehabilitation technology wheelchair
269269 supplier that provides equipment to a consumer may offer annual
270270 preventative maintenance on the complex rehabilitation technology
271271 wheelchair according to manufacturer guidelines.
272272 (b) All preventative maintenance shall be performed by a qualified
273273 technician who is an employee of the qualified complex rehabilitation
274274 technology supplier.
275275 (c) A health insurer and a managed care organization providing state
276276 medicaid services under the Kansas medicaid assistance program shall
277277 provide coverage and payment for complex rehabilitation technology
278278 preventative maintenance services at least annually, including, but limited
279279 to, labor, parts, diagnostic services, evaluations, travel and other related
280280 costs.
281281 (d) A health insurer and a managed care organization providing state
282282 medicaid services under the Kansas medical assistance program shall
283283 cover and pay for preventative maintenance services without requiring
284284 prior authorization or medical necessity documentation.
285285 (e) Documentation of all preventative maintenance services
286286 performed by a qualified complex rehabilitation technology supplier
287287 pursuant to this section shall be maintained by the qualified supplier.
288288 Sec. 5. This act shall take effect and be in force from and after
289289 January 1, 2025, and its publication in the statute book.
290290 1
291291 2
292292 3
293293 4
294294 5
295295 6
296296 7
297297 8
298298 9
299299 10
300300 11
301301 12
302302 13
303303 14
304304 15
305305 16
306306 17
307307 18
308308 19
309309 20
310310 21
311311 22
312312 23
313313 24
314314 25
315315 26
316316 27
317317 28
318318 29
319319 30
320320 31
321321 32
322322 33
323323 34
324324 35
325325 36
326326 37
327327 38
328328 39
329329 40
330330 41
331331 42