LRB-4970/1
SWB:amn
2019 - 2020 LEGISLATURE
December 6, 2019 - Introduced by Senators Testin, Johnson, Marklein, Larson,
Risser, L. Taylor and Wanggaard, cosponsored by Representatives
Thiesfeldt, Anderson, Skowronski, Bowen, Brooks, Brostoff, Considine,
Crowley, Dittrich, Duchow, James, Krug, Murphy, Neubauer, Ohnstad,
Rohrkaste, Sargent, Shankland, Sinicki, Spiros, Stafsholt, Steffen,
Subeck, C. Taylor, Tusler, Vining, Vruwink and Wichgers. Referred to
Committee on Health and Human Services.
SB605,1,3
1An Act to amend 49.45 (9r) (a) 2.; and
to create 49.45 (9r) (d) of the statutes;
2relating to: reimbursement under the Medical Assistance program for
3complex rehabilitation technology.
Analysis by the Legislative Reference Bureau
This bill modifies the definition of complex rehabilitation technology and
requires the Department of Health Services to defer to the determination of a
physician regarding the medical necessity of a complex rehabilitation technology
item or service and, upon a physician's determination of medical necessity, consider
a complex rehabilitation technology item or service for a complex needs patient as
medically necessary for purposes of reimbursement under this Medical Assistance
program. Under current law, “complex rehabilitation technology” is defined as 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 activities of daily living and instrumental
activities of daily living that are identified as medically necessary. Under the
Medical Assistance program, an item or service must be “medically necessary” in
order to be eligible for reimbursement. The bill specifically identifies power seat
elevation and power standing components of power wheelchairs as items that are
included in the definition of “complex rehabilitation technology.” Under the bill,
DHS is required to defer to a physician's determination of medical necessity and,
when a physician makes such a determination, conclusively find that a complex
rehabilitation technology item or service for a complex needs patient is medically
necessary for purposes of reimbursement under the Medical Assistance program.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB605,1
1Section 1
. 49.45 (9r) (a) 2. of the statutes is amended to read:
SB605,2,102
49.45
(9r) (a) 2. “Complex rehabilitation technology" means items classified
3within Medicare as durable medical equipment that are individually configured for
4individuals to meet their specific and unique medical, physical, and functional needs
5and capacities for basic activities of daily living and instrumental activities of daily
6living identified as medically necessary. “Complex rehabilitation technology”
7includes complex rehabilitation manual and power wheelchairs, adaptive seating
8and positioning items, and other specialized equipment such as standing frames and
9gait trainers,
power seat elevation or power standing components of power
10wheelchairs, as well as options and accessories related to any of these items.
SB605,2
11Section 2
. 49.45 (9r) (d) of the statutes is created to read:
SB605,2,1612
49.45
(9r) (d) The department shall defer to the determination of a physician
13regarding the medical necessity of a complex rehabilitation technology item or
14service for a complex needs patient and shall find, upon the determination of a
15physician, that a complex rehabilitation technology item or service for a complex
16needs patient is medically necessary.
