Michigan:
As of February 22, 2021, the state has rules related to prior authorization requirements for complex rehabilitation technology under Act 280 of 1939 s. 400.111j. The Medicaid agency may require prior authorization for medical equipment with a 15 work day review period. The agency has determined that prior authorization is required for complex rehabilitation technology when it costs more than $500. Additional legislation specific to complex rehabilitation technology is pending. See http://www.legislature.mi.gov/(S(frku1nkfpr41gffeyrprsvug))/mileg.aspx?page=GetObject&objectname=2021-SB-0500. Minnesota:
As of June 23, 2022, the state has rules related to prior authorization requirements for complex rehabilitation technology under Minn. Stats. s. 256B.0625 subd. 25. and Minn. Admin. Code 9505.0310. State Medicaid policy: “A provider who furnishes durable medical equipment for a recipient who is a resident of a hospital or long-term care facility may submit a separate claim for medical assistance payment if the equipment has been modified for the recipient or the item is necessary for the continuous care and exclusive use of the recipient to meet the recipient's unusual medical need according to the written order of a physician.”
Summary of factual data and analytical methodologies
The department relied on requirements set forth in s. 49.45 (9r) (e), Stats. Analysis and supporting documents used to determine effect on small business
The department published a solicitation in the Administrative Register from___ to___, in which it requested comments on the economic impact of the proposed rule.
Effect on small business
Based on the economic impact public commenting period and the analysis provided in fiscal estimate and economic impact analysis, the proposed rule is anticipated to have little to no economic impact on small businesses.
Agency contact person
Statement on quality of agency data
The data used by the Department to prepare these proposed rules and analysis comply with s. 227.14 (2m), Stats. Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active. RULE TEXT
SECTION 1. DHS 107.24 (4) (c) 2. is renumbered DHS 107.24 (4) (c) 2. (intro.) and amended to read:
DHS 107.24 (4) (c) 2. Durable medical equipment which is personalized in nature or custom-made for a recipient and is to be used by the recipient on an individual basis for hygienic or other reasons. These items are orthoses, prostheses including hearing aids or other assistive listening devices, orthopedic or corrective shoes, special adaptive positioning wheelchairs and electric wheelchairs and complex rehabilitation technology. Coverage and reimbursement of a special adaptive positioning wheelchair or electric wheelchair shall be justified by the diagnosis and prognosis and the occupational or vocational activities of the resident recipient; and complex rehabilitation technology shall require prior authorization when prescribed by a physician, meet medical necessity standards, and meet all complex rehabilitation standards as defined in DHS 107.24(3)(i). The complex rehabilitation technology must do any of the following:
SECTION 2. DHS 107.24 (4) (c) 2. a. to c. are created to read:
DHS 107.24 (4) (c) 2. a. Contribute to the member’s independent completion of activities of daily living.
b. Support the member’s occupational, vocational, or psychosocial activities.
c. Provide the member the independent ability to move about the facility, or to attain or retain self-care.
SECTION 3. DHS 107.24 (4) (c) 3. is repealed.
SECTION 4. EFFECTIVE DATE. This rule takes effect on the first day of the month following publication in the Wisconsin Administrative Register, as provided in s. 227.22 (2) (intro.), Stats.
