Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 1445

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Durable medical equipment is considered an optional service for state Medicaid programs which is currently covered in Washington. Durable medical equipment is defined as equipment that: (1) can withstand repeated use; (2) is primarily and customarily used to serve a medical purpose; (3) is generally not useful to a person in the absence of an illness or injury; and (4) is appropriate for use in the client's residence.

Wheelchairs are considered durable medical equipment under the Medicaid program. There are several different categories of wheelchairs. Manual wheelchairs are nonmotorized and capable of being independently propelled. Manual wheelchairs may be classified as standard, lightweight, high-strength lightweight, hemi, pediatric, recliner, tilt-in-space, heavy duty, rigid, custom heavy-duty, and custom manufactured specialty-built. Power wheelchairs are motorized wheelchairs that can be independently driven by a client. Power wheelchairs may be classified as pediatric, noncustomized power, or customized power.

Summary of Bill:

The Health Care Authority (Authority) is directed to establish a separate recognition for medically necessary, individually configured, complex rehabilitation technology products and services for complex medical need patients in the Medical Assistance program. The Authority must designate appropriate current billing codes as complex rehabilitation technology and establish new billing codes as necessary. The Authority must establish standards for qualified complex rehabilitation technology suppliers and may only purchase complex rehabilitation technology from those suppliers.

"Complex needs patients" are defined as individuals with a diagnosis or medical condition that results in significant physical or functional needs and capacities. The term includes people with progressive or degenerative neuromuscular diseases or injuries or trauma which have resulted in significant physical or functional needs and limited capacities, such as spinal cord injury, traumatic brain injury, cerebral palsy, and muscular dystrophy.

"Complex rehabilitation technology" is defined as items defined by Medicare as durable medical equipment that are specially configured to meet the specific medical, physical, and functional needs of individuals. Complex rehabilitation technology is primarily used to serve a medical purpose and requires patient evaluations and fitting services to establish the appropriate design, configuration, and use of the equipment. The term specifically includes highly configurable wheelchairs, complex rehabilitation power wheelchairs, and adaptive seating and positioning systems.

"Qualified complex rehabilitation technology supplier" means an entity that: (1) is accredited as a supplier of complex rehabilitation technology; (2) meets Medicare standards for durable medical equipment suppliers; (3) employs at least one complex rehabilitation technology professional at each site who is physically present to assess patient needs and assist in product selection and training; and (4) provides service and repairs for the products that it sells, as well as information about receiving service and repair.