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House
File
500
-
Introduced
HOUSE
FILE
500
BY
BODEN
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
the
maintenance
and
1
repair
of
complex
rehabilitation
technology
wheelchairs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
2710YH
(2)
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H.F.
500
Section
1.
NEW
SECTION
.
514M.1
Definitions.
1
For
purposes
of
this
chapter,
unless
the
context
otherwise
2
requires:
3
1.
“Commissioner”
means
the
commissioner
of
insurance.
4
2.
“Complex
rehabilitation
technology
wheelchair”
means
a
5
complex
rehabilitation
manual
or
power
wheelchair,
classified
6
by
Medicare
as
durable
medical
equipment,
that
is
individually
7
configured
for
a
patient
to
meet
the
patient’s
specific
and
8
unique
medical,
physical,
and
functional
needs
and
capacities
9
for
basic
activities
of
daily
living
and
instrumental
10
activities
of
daily
living
identified
as
medically
necessary,
11
and
includes
the
options
and
accessories
related
to
the
complex
12
rehabilitation
manual
or
power
wheelchair.
13
3.
“Covered
person”
means
a
policyholder,
subscriber,
or
14
other
person
participating
in
a
policy,
contract,
or
plan
that
15
provides
for
third-party
payment
or
prepayment
of
health
or
16
medical
expenses.
17
4.
“Department”
means
the
department
of
health
and
human
18
services.
19
5.
“Health
care
professional”
means
the
same
as
defined
in
20
section
514J.102.
21
6.
“Health
carrier”
means
an
entity
subject
to
the
22
insurance
laws
and
regulations
of
this
state,
or
subject
23
to
the
jurisdiction
of
the
commissioner,
including
an
24
insurance
company
offering
sickness
and
accident
plans,
a
25
health
maintenance
organization,
a
nonprofit
health
service
26
corporation,
a
plan
established
pursuant
to
chapter
509A
27
for
public
employees,
or
any
other
entity
providing
a
plan
28
of
health
insurance,
health
care
benefits,
or
health
care
29
services.
30
7.
“Medical
assistance”
means
the
same
as
defined
in
section
31
249A.2.
32
8.
“Patient”
means
an
individual
who
resides
in
the
33
state,
who
is
a
recipient,
and
who
has
a
diagnosis
or
medical
34
condition
that
results
in
significant
physical
impairment
or
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functional
limitation.
1
9.
“Qualified
complex
rehabilitation
technology
professional”
2
means
an
individual
who
is
certified
as
an
assistive
technology
3
professional
by
the
rehabilitation
engineering
and
assistive
4
technology
society
of
North
America.
5
10.
“Qualified
complex
rehabilitation
technology
wheelchair
6
supplier”
or
“qualified
supplier”
means
an
entity
that
meets
all
7
of
the
following
criteria:
8
a.
The
entity
is
accredited
by
a
recognized
accrediting
9
organization
as
a
supplier
of
complex
rehabilitation
technology
10
wheelchairs.
11
b.
The
entity
employs
at
least
one
qualified
complex
12
rehabilitation
technology
professional
to
analyze
the
needs
and
13
capacities
of
a
patient
or
a
covered
person
in
consultation
14
with
the
patient’s
or
covered
person’s
prescribing
health
care
15
professional,
to
participate
in
the
selection
of
an
appropriate
16
complex
rehabilitation
technology
wheelchair
for
the
needs
and
17
capacities
of
the
patient
or
the
covered
person,
and
to
provide
18
training
in
the
proper
use
of
the
complex
rehabilitation
19
technology
wheelchair.
20
c.
The
entity
requires
a
qualified
complex
rehabilitation
21
technology
professional
to
be
physically
present
for
the
22
evaluation
and
determination
of
an
appropriate
complex
23
rehabilitation
technology
wheelchair
for
a
patient
or
a
covered
24
person.
25
d.
The
entity
has
the
capability
to
provide
service
and
26
repairs,
performed
by
qualified
technicians,
for
all
complex
27
rehabilitation
technology
wheelchairs
sold
by
the
qualified
28
supplier.
29
e.
At
the
time
of
delivery
of
a
complex
rehabilitation
30
technology
wheelchair
to
a
patient
or
a
covered
person,
the
31
entity
provides
written
information
that
explains
how
the
32
patient
or
covered
person
may
receive
service,
repairs,
and
33
annual
preventative
maintenance
for
the
complex
rehabilitation
34
technology
wheelchair.
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11.
“Recipient”
means
a
person
who
receives
medical
1
assistance
under
chapter
249A.
2
12.
“Third-party
payor”
means
health
carriers
and
other
3
entities
that
provide
a
plan
of
health
insurance
or
health
care
4
benefits.
5
Sec.
2.
NEW
SECTION
.
514M.2
Complex
rehabilitation
6
technology
wheelchairs
——
service
and
repairs.
7
1.
Beginning
January
1,
2026,
a
qualified
complex
8
rehabilitation
technology
wheelchair
supplier
that
provides
a
9
complex
rehabilitation
technology
wheelchair
to
a
patient
or
10
to
a
covered
person
shall
be
required
to
provide
service
and
11
repairs
of
the
complex
rehabilitation
technology
wheelchair
12
as
requested
by
the
patient
or
the
covered
person,
or
the
13
patient’s
or
covered
person’s
prescribing
health
care
14
professional,
except
in
the
following
circumstances:
15
a.
The
patient
or
covered
person
moves
out
of
state
after
16
receiving
the
complex
rehabilitation
technology
wheelchair.
17
b.
The
patient
or
covered
person
presents
a
safety
risk
to
18
any
of
the
qualified
supplier’s
staff
members.
19
c.
The
patient
or
covered
person
is
no
longer
a
recipient
or
20
a
covered
person.
21
2.
A
third-party
payor
shall
not
require
any
of
the
22
following
in
order
for
a
qualified
complex
rehabilitation
23
technology
wheelchair
supplier
to
provide
service
and
repairs
24
under
this
section:
25
a.
Prior
authorization.
26
b.
Documentation
of
continued
medical
necessity.
27
3.
Documentation
of
all
service
and
repairs
completed
by
a
28
qualified
complex
rehabilitation
technology
wheelchair
supplier
29
under
this
section
shall
be
maintained
by
the
qualified
30
supplier.
The
documentation
shall
not
be
subject
to
audit
by
a
31
third-party
payor.
32
Sec.
3.
NEW
SECTION
.
514M.3
Complex
rehabilitation
33
technology
wheelchairs
——
annual
preventative
maintenance.
34
1.
Beginning
July
1,
2026,
a
qualified
complex
35
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rehabilitation
technology
wheelchair
supplier
that
provides
a
1
complex
rehabilitation
technology
wheelchair
to
a
patient
or
to
2
a
covered
person
shall
be
required
to
offer
annual
preventative
3
maintenance
on
the
complex
rehabilitation
technology
wheelchair
4
except
in
the
following
circumstances:
5
a.
The
patient
or
covered
person
moves
out
of
state
after
6
receiving
the
complex
rehabilitation
technology
wheelchair.
7
b.
The
patient
or
covered
person
presents
a
safety
risk
to
8
any
of
the
qualified
supplier’s
staff
members.
9
c.
The
patient
or
covered
person
is
no
longer
a
recipient
or
10
a
covered
person.
11
2.
All
preventative
maintenance
shall
be
performed
by
12
a
qualified
technician
who
is
an
employee
of
the
qualified
13
complex
rehabilitation
technology
wheelchair
supplier.
14
3.
All
third-party
payors
shall
ensure
that
the
annual
15
preventative
maintenance
benefit
is
communicated
in
written
16
form
to
all
patients
or
covered
persons.
17
4.
Annual
preventative
maintenance
shall
be
scheduled
by
18
the
qualified
complex
rehabilitation
technology
wheelchair
19
supplier
at
the
request
of
the
patient
or
covered
person,
or
20
the
patient’s
or
covered
person’s
health
care
professional.
21
If
the
patient
or
covered
person
does
not
request
annual
22
preventative
maintenance,
the
qualified
supplier
shall
contact
23
the
patient
or
covered
person
and
schedule
preventative
24
maintenance
at
a
time
that
is
mutually
convenient
for
both
25
parties.
Annual
preventative
maintenance
may
also
be
performed
26
during
the
provision
of
service
and
repairs
under
section
27
514M.2.
28
5.
Annual
preventative
maintenance
may
be
performed
at
the
29
qualified
supplier’s
facility,
or
at
a
wheelchair
clinic
or
30
other
health
care
facility.
31
6.
A
third-party
payor
shall
not
require
any
of
the
32
following
in
order
for
a
qualified
complex
rehabilitation
33
technology
wheelchair
supplier
to
perform
annual
preventative
34
maintenance
under
this
section:
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500
a.
Prior
authorization.
1
b.
Documentation
of
continued
medical
necessity.
2
7.
Documentation
of
all
preventative
maintenance
performed
3
by
a
qualified
complex
rehabilitation
technology
wheelchair
4
supplier
pursuant
to
this
section
shall
be
maintained
by
the
5
qualified
supplier.
The
documentation
shall
not
be
subject
to
6
audit
by
a
third-party
payor.
7
Sec.
4.
NEW
SECTION
.
514M.4
Third-party
payors
——
8
applicability.
9
1.
This
chapter
applies
to
the
following
classes
of
10
third-party
payment
provider
contracts,
policies,
or
plans
11
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
12
state
on
or
after
January
1,
2026:
13
a.
Individual
or
group
accident
and
sickness
insurance
14
providing
coverage
on
an
expense-incurred
basis.
15
b.
An
individual
or
group
hospital
or
medical
service
16
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
17
c.
An
individual
or
group
health
maintenance
organization
18
contract
regulated
under
chapter
514B.
19
d.
A
plan
established
for
public
employees
pursuant
to
20
chapter
509A.
21
e.
The
medical
assistance
program
under
chapter
249A
22
including
all
managed
care
organizations
acting
pursuant
to
a
23
contract
with
the
department
of
health
and
human
services
to
24
administer
the
medical
assistance
program.
25
2.
This
chapter
shall
not
apply
to
accident-only,
26
specified
disease,
short-term
hospital
or
medical,
hospital
27
confinement
indemnity,
credit,
dental,
vision,
Medicare
28
supplement,
long-term
care,
basic
hospital
and
medical-surgical
29
expense
coverage
as
defined
by
the
commissioner,
disability
30
income
insurance
coverage,
coverage
issued
as
a
supplement
31
to
liability
insurance,
workers’
compensation
or
similar
32
insurance,
or
automobile
medical
payment
insurance.
33
Sec.
5.
NEW
SECTION
.
514M.5
Task
force
——
reimbursement
34
rates.
35
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1.
The
division
and
the
department
shall
form
a
task
1
force
whose
members
shall
include
the
commissioner
or
the
2
commissioner’s
designee,
the
director
or
the
director’s
3
designee,
two
representatives
from
Iowa-based
qualified
complex
4
rehabilitation
technology
wheelchair
suppliers,
two
Iowa-based
5
qualified
complex
rehabilitation
technology
professionals,
two
6
patients
or
the
patients’
representatives,
two
covered
persons
7
or
the
covered
person’s
representative,
and
two
representatives
8
of
third-party
payors.
All
members
of
the
task
force
shall
be
9
reimbursed
for
all
actual
and
necessary
expenses
incurred
in
10
the
performance
of
duties
as
a
member
of
the
task
force.
11
2.
The
task
force
shall
annually
review
and
determine
all
12
of
the
following:
13
a.
The
reimbursement
rate
for
service
and
repairs
completed
14
under
section
514M.2.
The
reimbursement
rate
shall
include
15
all
related
diagnostic
and
evaluation
time,
related
labor,
16
necessary
parts,
and
reasonable
travel
time.
17
b.
The
reimbursement
rate
for
preventative
maintenance
18
completed
under
section
514M.3.
The
reimbursement
rate
shall
19
include
all
related
diagnostic
and
evaluation
time,
related
20
labor,
necessary
parts,
and
reasonable
travel
time.
21
c.
The
scope
of
the
preventative
maintenance
required
under
22
section
514M.3.
23
Sec.
6.
NEW
SECTION
.
514M.6
Rules.
24
The
division
and
the
department
shall
adopt
joint
rules
25
pursuant
to
chapter
17A
as
necessary
to
administer
this
26
chapter.
27
EXPLANATION
28
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
29
the
explanation’s
substance
by
the
members
of
the
general
assembly.
30
This
bill
relates
to
insurance
coverage
for
the
maintenance
31
and
repair
of
complex
rehabilitation
technology
wheelchairs.
32
Beginning
January
1,
2026,
the
bill
requires
a
qualified
33
complex
rehabilitation
technology
wheelchair
supplier
34
(qualified
supplier)
that
provides
a
complex
rehabilitation
35
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8
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500
technology
wheelchair
(wheelchair)
to
a
patient
or
a
covered
1
person
to
provide
service
and
repairs
on
the
wheelchair
as
2
requested
by
the
patient
or
covered
person,
or
the
patient’s
3
or
covered
person’s
prescribing
health
care
professional,
4
except
in
the
circumstances
detailed
in
the
bill.
“Qualified
5
supplier”,
“patient”,
“covered
person”,
and
“complex
6
rehabilitation
technology
wheelchair”
are
defined
in
the
bill.
7
The
bill
prohibits
a
third-party
payor
from
requiring
prior
8
authorization
or
documentation
of
continued
medical
necessity
9
in
order
for
a
qualified
supplier
to
provide
service
and
10
repairs
under
the
bill.
“Third-party
payor”
is
defined
in
the
11
bill.
12
Documentation
of
all
service
and
repairs
completed
by
a
13
qualified
supplier
under
the
bill
shall
be
maintained
by
14
the
qualified
supplier,
and
are
not
subject
to
audit
by
a
15
third-party
payor.
16
Beginning
July
1,
2026,
a
qualified
supplier
that
provides
17
a
wheelchair
to
a
patient
shall
be
required
to
offer
annual
18
preventative
maintenance
(PM)
on
the
wheelchair,
except
in
the
19
circumstances
detailed
in
the
bill.
The
bill
requires
that
all
20
PM
be
performed
by
a
qualified
technician
who
is
an
employee
of
21
the
qualified
supplier.
All
third-party
payors
shall
ensure
22
that
the
annual
PM
benefit
is
communicated
in
written
form
to
23
all
patients.
24
The
PM
must
be
scheduled,
and
performed
in
a
location,
as
25
detailed
in
the
bill.
A
third-party
payor
shall
not
require
26
prior
authorization
or
documentation
of
continued
medical
27
necessity
in
order
for
a
qualified
supplier
to
perform
annual
28
PM.
Documentation
of
all
PM
shall
be
maintained
by
the
29
qualified
supplier
and
shall
not
be
subject
to
audit
by
a
30
third-party
payor.
31
The
bill
applies
to
third-party
payment
providers
enumerated
32
in
the
bill,
including
the
medical
assistance
program
(program)
33
under
Code
chapter
249A
and
managed
care
organizations
acting
34
pursuant
to
a
contract
with
the
department
of
health
and
human
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500
services
(HHS)
to
administer
the
program.
The
bill
specifies
1
the
types
of
specialized
health-related
insurance
which
are
not
2
subject
to
the
bill.
3
The
bill
requires
the
division
of
insurance
(division)
and
4
HHS
to
form
a
task
force
made
up
of
members
as
detailed
in
the
5
bill.
All
members
of
the
task
force
shall
be
reimbursed
for
6
all
actual
and
necessary
expenses
incurred
in
the
performance
7
of
duties
as
a
member
of
the
task
force.
The
task
force
shall
8
annually
review
and
determine
the
reimbursement
rate
(rate)
9
for
service
and
repairs
completed
under
the
bill,
and
the
rate
10
shall
include
all
related
evaluation
and
diagnostic
time,
11
related
labor,
necessary
parts,
and
reasonable
travel
time;
12
the
rate
for
PM
completed
under
the
bill,
and
the
rate
shall
13
include
all
related
evaluation
and
diagnostic
time,
related
14
labor,
necessary
parts,
and
reasonable
travel
time;
and
the
15
scope
of
the
PM
required
under
the
bill.
16
The
division
and
HHS
shall
adopt
joint
rules
as
necessary
to
17
administer
the
bill.
18
-8-
LSB
2710YH
(2)
91
nls/ko
8/
8