SS 037-19

STATEMENT OF SCOPE WISCONSIN DEPARTMENT OF HEALTH SERVICES

CHAPTER:         DHS 101

        DHS 105

      DHS 107

RELATING TO:   Introductions and Definitions

        Provider Certification

        Covered Services

RULE TYPE:         Permanent

SCOPE TYPE:     Original

SUMMARY

1.

Description of rule objective/s

In 2017 Wis. Act 306, the Wisconsin Legislature directed the Department to promulgate rules and implement policy to define complex rehabilitation technology, define provider certification for providers, and define under what circumstances complex rehabilitation technology may be covered or reimbursed by Medicaid fee-for-service and managed care organizations.

2.

Existing policies relevant to the rule

DHS 105.40 Durable medical equipment and medical supply vendors

DHS 107.24, Durable Medical Equipment

3.

Policies proposed to be included in the rule

Wisconsin 2017 Act 306 requires the Department to promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. Specific directives and parameters for the rulemaking are stated in the Act.

4.

Analysis of policy alternative

There are no reasonable alternatives to the proposed rulemaking. The Legislature has explicitly directed the department to submit the proposed rules to the legislative council staff no later than the first day of the 13th month beginning after the effective date of Section 3. of the Act.

5.

Statutory authority for the rule

a.

Explanation of authority to promulgate the proposed rule

The Department’s authority to promulgate the proposed rules is provided in s. 49.45 (9r) (b), Stats., and in 2017 Wis. Act. 306, Section 3.

b.

Statute/s that authorize/s the promulgation of the proposed rule

Section 49.45 (9r) (b) reads:

(b) The department shall promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. The department shall include in the rules all of the following:

1. Designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes. The department shall include provisions allowing quarterly updates to the designations under this subdivision.

2. Establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers.

3. A requirement that Medical Assistance recipients who need a complex rehabilitation manual wheelchair, complex rehabilitation power wheelchair, or other complex rehabilitation seating component to be evaluated by all of the following:

a. A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier.

b. A qualified complex rehabilitation technology professional.

4. Establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure, and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients.

5. A requirement for contracts with the department that managed care plans providing services to Medical Assistance recipients comply with this subsection and the rules promulgated under this subsection.

6. Protection of access to complex rehabilitation technology for complex needs patients.