Home health agencies and pharmacies that currently dispense complex rehabilitation technology
Occupational therapists
Boarder state providers. (No border state has a complex rehabilitation technology benefit.)
Medicaid Managed Care Organizations
Nursing Homes (Power wheelchairs are not included in the nursing home daily rate)8.
Summary and preliminary comparison of any existing or proposed federal regulation that is intended to address the activities to be regulated by the rule2017 Wisconsin Act 306 requires the Department to designate within the promulgated rules the healthcare common procedure coding system (HCPCS) codes that are used in the federal Medicare program for complex rehabilitation technology. There are no Medicare designated complex rehabilitation technology codes at this time. However, Congressional House Bill HR 750 was referred to subcommittee in February 2017. This bill would amend title XVIII (Medicare) of the Social Security Act to establish a separate Medicare benefit category for complex rehabilitation technology (CRT) items that: (1) are designed or configured to meet an individual's unique needs and capacities; (2) are primarily used to serve a medical or functional purpose; and (3) require certain services to ensure appropriate design, configuration, and use. The Centers for Medicare & Medicaid Services (CMS) shall designate CRT items and establish eligibility criteria with respect to such items, in accordance with specified exclusions and other requirements. The CMS must also establish: (1) a payment system applicable to CRT items, subject to clinical conditions and other specified requirements; (2) quality standards for suppliers of CRT items; and (3) a formal process for the submission of certain CRT code-set modification requests by stakeholder groups.
If specified requirements are met, Medicare payment must be made for the replacement of a CRT item (or item part), without regard to certain continuous-use or useful-lifetime restrictions applicable to items of durable medical equipment.
In addition, Medicare payment may be made for the temporary rental of a CRT item if such an item owned by a qualified enrollee is undergoing necessary repairs.
9.
Anticipated economic impact, locally or statewide
10.
Agency contacts
Hannah CrucksonProject Coordinator
Long Term Care Benefits and Programs
Division of Medicaid Services Administrator’s Office
Wisconsin Department of Health Services
1 West Wilson Street
Madison, WI 53703
608-267-3660
DHS Secretary | Date Submitted for Governor Approval |