SB 308 — AN ACT CONCERNING WHEELCHAIR REPAIR REQUIREMENTS.

Section(NEW) 17b-278j(Effective ofJuly the1, general2024) statutes(a) There is repealedestablished a complex rehabilitation technology and thewheelchair followingrepair isadvisory substitutedcouncil to monitor repairs of wheelchairs, including complex rehabilitation technology wheelchairs, as defined in lieusection thereof1 (Effectiveof Octoberthis 1,act, 2024):and to make recommendations concerning improving repair times.

(a)Public AsAct usedNo. in this section:

(1)24-58 "Authorized4 wheelchairof dealer"7 hasSubstitute theSenate sameBill meaningNo. as provided in section 1 of this act.

(2)308 "Complex(b) rehabilitationThe technology"advisory meanscouncil productsshall classifiedconsist asof durable medical equipment within the Medicarefollowing programmembers: as of January 1, 2013, that are individually configured and medically necessary for individuals to meet their specific and unique medical, physical and functional needs and capacities for basic and instrumental activities of daily living.

Complex(1) rehabilitationTwo technologyappointed includes,by butthe House and Senate chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to human services, one of whom is nota limitedconsumer to,who (A)uses a complex rehabilitation manualtechnology andwheelchair powerpurchased, wheelchairsleased andor accessories,repaired (B)under adaptivethe seatingMedicaid program, and positioningone itemsof andwhom accessories,is anda (C)representative otherofthestate specializedadvocacy equipmentsystemfor andpersonswithdisabilities, accessories,established suchpursuant asto standingsection frames46a-10b andof gaitthe trainers.general statutes;

(3)(2) "ComplexTwo appointed by the House and Senate ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to human services, one of whom is a consumer who uses a complex rehabilitation technology wheelchair"wheelchair haspurchased, theleased sameor meaningrepaired under a private health insurance policy, and one of whom is an authorized wheelchair dealer, as provideddefined in section 1 of this act.act;

[(2)](3) (4)Two "Employee"appointed meansby athe personHouse whoseand taxesSenate arechairpersons withheldof bythe joint standing committee of the General Assembly having cognizance of matters relating to general law, each of whom is a sSB308representative /of Filean No.organization that represents persons with physical disabilities;

311(4) 4Two sSB308appointed Fileby No.the House and Senate ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to general law, each of whom is a consumer who privately pays for complex rehabilitation technology wheelchairs;

311(5) qualifiedThe complexCommissioner rehabilitationof technologyAging supplier and reportedDisability toServices, or the Internalcommissioner's Revenuedesignee; Service.

[(3)](6) (5)The "HealthcareInsurance CommonCommissioner, Procedure Coding System" or "HCPCS" means the billingcommissioner's codesdesignee; used by Medicare and overseen by the federal Centers for Medicare and Medicaid Services that are based on the current procedural technology codes developed by the American Medical Association.

[(4)](7) (6)The "IndividuallyCommissioner configured" means a device with a combination of sizes,Social features,Services, adjustments or modifications that is customized by a qualified complex rehabilitation technology supplier for a specific individual by measuring, fitting, programming, adjusting or adapting the devicecommissioner's sodesignee; that the device is consistent with the individual's medical condition, physical and functional needs and capacities, body size, period of need and intended use as determined by an assessment or evaluation by a qualified health care professional.

[(5)]Public (7)Act "MedicallyNo. necessary" has the same meaning as provided in section 17b-259b.

[(6)]24-58 (8)5 "Mixed HCPCS codes" means codes that refer to a mix of complex7 rehabilitationSubstitute technologySenate productsBill andNo. standard mobility and accessory products.

[(7)]308 (9)(8) "PureThe HCPCSHealthcare codes"Advocate, meansor codesthe thatHealthcare referAdvocate's exclusivelydesignee; to complex rehabilitation technology products and services.

[(8)] (10) "Qualified complex rehabilitation technology professional" means an individual who is certified as an Assistive Technology Professional by the Rehabilitation Engineering and Assistive(9)The TechnologyCommissioner SocietyofConsumer ofProtection,orthecommissioner's Northdesignee. America.

[(9)](c) (11)Any "Qualifiedmember complexof rehabilitationtheadvisory technologycouncil supplier"appointed meansunder asubdivision company(1), (2), (3) or entity(4) that:of subsection (b) of this section may be a member of the General Assembly.

(A)(d) IsAll accreditedinitial byappointments ato recognizedthe accreditingadvisory organizationcouncil asshall abe suppliermade ofnot complexlater rehabilitationthan technology;August 1, 2024.

sSB308Any /vacancy Fileshall No.be filled by the appointing authority.

311The 5advisory sSB308council Fileshall No.meet at least monthly.

311(e) (B)The IsCommissioner anof enrolledAging Medicareand supplierDisability andServices, meetsor the suppliercommissioner's designee, and qualitya standardsmember establishedof forthe durableadvisory medicalcouncil equipment,chosen includingby thosea formajority aof complexmembers rehabilitationof technologythe supplieradvisory undercouncil, theshall Medicareserve program;as chairpersons.

(C)Such Haschairpersons atshall leastschedule onethe employeefirst whomeeting isof a qualified complex rehabilitation technology professional for each service location to (i) analyze theneedsandcapacitiesofaneligible individualinconsultation with a qualified health care professional, (ii) participate in the selectionadvisory ofcouncil appropriatenot coveredlater complexthan rehabilitationSeptember technology1, for2024. such needs and capacities, and (iii) provide technology-related training inthe proper use of the complex rehabilitation technology;

(D)(f) RequiresThe aadministrative qualifiedstaff complexof rehabilitationthe technologyjoint professionalstanding becommittee physicallyof present for the evaluationGeneral andAssembly determinationhaving cognizance of appropriatematters complexrelating rehabilitationto technologyhuman forservices anshall eligibleserve individual;as administrative staff of the advisory council.

(E)(g) HasNot later than January 1, 2025, and annually thereafter, the capabilityadvisory council shall submit a report on its findings and recommendations to providethe servicejoint standing committees of the General Assembly having cognizance of matters relating to aging, general law, human services and repairinsurance, byin qualifiedaccordance technicianswith forthe allprovisions complexof rehabilitationsection technology11-4a itof sells;the general statutes.

and (F) Provides written information regarding how to receive service and repair of complex rehabilitation technology to the eligible individual at the time such technology is delivered.

[(10)] (12) "Qualified health care professional" means a health care professional licensed by the state Department of Public Health who has no financial relationship with a qualified complex rehabilitation technology supplier.

Qualified health care professional includes, but is not limited to, (A) a licensed physician, (B) a licensed physical therapist, (C) a licensed occupational therapist, or (D) other licensed health care professional who performs specialty evaluations within the professional's scope of practice.

(13) "Timely repair" has the same meaning as provided in section 1 of this act.

(b) The Commissioner of Social Services shall, not later than January sSB308 / File No.

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311 1, 2015, report to the joint standing committee of the General Assembly having cognizance of matters relating to human services on the impact of:

(1) Designating products and services included in mixed and pure HCPCS billing codes as complex rehabilitation technology;

(2) setting minimum standards consistent with subdivision [(9)] (11) of subsection (a) of this section in order for suppliers to be considered qualified complex rehabilitation technology suppliers eligible for Medicaid reimbursement;

(3) preserving the option for complex rehabilitation technology to be billed and paid for as a purchase allowing for single payments for devices with a length of need of one year or greater, excluding approved crossover claims for clients enrolled in Medicare andMedicaid;and(4)requiringeligibleindividualsreceivingacomplex rehabilitation manual wheelchair, power wheelchair or seating component to be evaluated by a qualified health care professional and a qualified complex rehabilitation technology professional to qualify for reimbursement.

(c) The Commissioner of Social Services shall not require a new prescription for the purchase or repair of complex rehabilitation technology, including a complex rehabilitation technology wheelchair, unless the original prescription is more than five years old.

The commissioner shall not require prior authorization for timely repair of a complex rehabilitation technology wheelchair, if the original prescription was written not more than five years earlier.

(d) The commissioner, to the extent permissible under federal law, shall provide Medicaid coverage for annual maintenance of a Medicaid recipient's complex rehabilitation technology wheelchair and any backup complex rehabilitation technology wheelchair that theMedicaid recipient may need during the repair of the primary complex rehabilitation technology wheelchair.

The commissioner shall amend the Medicaid state plan if necessary to implement the provisions of this section.

(e) The commissioner, following notice and opportunity for a hearing pursuant to chapter 54, may reduce or withhold Medicaid funding for sSB308 / File No.

311 7 sSB308 File No.

311 any authorized complex rehabilitation technology supplier or authorized wheelchair dealer who sells or leases wheelchairs to a Medicaidrecipient forviolationsoftheprovisionsofsection2ofthisact, regardless of whether the violation concerned a wheelchair purchased, leased or repaired under the Medicaid program.

If the violation did not concern a wheelchair purchased, leased or repaired under the Medicaid program, the commissioner may reduce or withhold such funding under any future contract with such authorized complex rehabilitation technology supplier or authorized wheelchair dealer for the purchase, lease or repair of a wheelchair, including a complex rehabilitation technology wheelchair, under the Medicaid program.

Subdivision(NEW) (Effective July 1, 2024) (a) As used in this section, (1) of"complex rehabilitation technology wheelchair" has the same meaning as provided in section 42-3301 of thethis generalact, statutesand is(2) repealed"medically andthefollowingnecessary" issubstitutedmeans inlieuthereof(EffectiveOctobera 1,written 2024):determination by a policy holder's health care provider that Public Act No.

(1)24-58 "Assistive6 technology device" means any device sold, leased or transferred in this state or to a consumer in this state on or after January 1, 1998, that is used or designed to be used to enable or enhance the ability of a7 personSubstitute withSenate aBill disability to communicate, see, hear or achieve mobility, including, but not limited to, (A) [manual or motor-driven wheelchairs and other] assistive devices that enhance a mobility impaired person's ability to achieve mobility, including seating and positioning aids, except for a wheelchair or complex rehabilitation technology wheelchair, as defined in section 1 of this act, (B) telephone communication devices for persons who are hard of hearing and other assistive listening devices that enhance the ability of a person who is hard of hearing to hear or communicate, but not including hearing aids, (C) voice synthesized computer modules, optical scanners, talking software, braille printers andother assistive devicesthat enhance a sight impaired person's ability to see or communicate, (D) computer equipment with voice output, artificial larynges, voice amplification devices and other alternative and augmentative communication devices, (E) any system of such devices that, as a whole, is itself such a device, (F) any component product of such devices that is itself ordinarily such a device, and (G) any such device used primarily by a sSB308 / File No.

311308 8repairorreplacementofa sSB308complexrehabilitationtechnology Filewheelchair No.is necessary to preserve the health of such policy holder.

311(b) dealer,Each lessorindividual health insurance policy providing coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a- delivered, issued for delivery, renewed, amended or manufacturercontinued in this state on and after January 1, 2025, shall not require a new prescription or prior authorization for the purposemedically necessary repair or replacement of demonstrationa tocomplex rehabilitation technology wheelchair unless the publicoriginal orprescription tois prospectivemore purchasersthan orfive lessees.years old.

"Assistive(c) technologyThe device"Insurance doesCommissioner notshall includeadopt batteriesregulations, used in oraccordance nonessentialwith accessorieschapter 54 of the general statutes, to anyimplement suchthe devices.provisions of this section.

ThisSec. act shall take effect as follows and shall amend the following sections:

Section6. 1 October 1, 2024 New section Sec.

2(NEW) October(Effective July 1, 20242024) New(a) As used in this section, (1) "complex rehabilitation technology wheelchair" has the same meaning as provided in section Sec.1 of this act, and (2) "medically necessary" means a written determination by a policy holder's health care provider that repairorreplacementofa complexrehabilitationtechnology wheelchair is necessary to preserve the health of such policy holder.

3(b) OctoberEach group health insurance policy providing coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a- delivered, issued for delivery, renewed, amended or continued in this state on and after January 1, 20242025, 17b-4shall Sec.not require a new prescription or prior authorization for the medically necessary repair or replacement of a complex rehabilitation technology wheelchair unless the original prescription is more than five years old.

4(c) OctoberThe 1,Insurance 2024Commissioner 17b-278jshall Sec.adopt regulations, in accordance with chapter 54 of the general statutes, to implement the provisions of this section.

5Approved OctoberMay 1,28, 2024 42-330(1)Public HSAct JointNo. Favorable Subst.

sSB30824-58 /7 Fileof No.7

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311 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 25 $ FY 26 $ Social Services, Dept.

GF - Potential See Below See Below Savings Social Services, Dept.

GF - Potential See Below See Below Revenue Gain Social Services, Dept.

GF - Potential See Below See Below Cost Note:

GF=General Fund Municipal Impact:

None Explanation The bill may result in a savings or potential revenue gain to the Department ofSocialServices(DSS)to theextent that certainauthorized complex rehabilitation technology (CRT) wheelchair dealers do not meet timely wheelchair repair requirements as specified in the bill.

The bill requires DSS to establish regulations regarding timely wheelchair repair and allows DSS to enforce penalties for not doing so, including, but not limited to, withholding Medicaid funding.

The bill may result in a cost to DSS to the extent that the department needs to hire additional staff to conduct fair hearings to meet the provisions of the bill.

For reference, the starting annual salary of a Fair Hearings Officer and Fair Hearings Supervisor is $80,824 and $93,567, CRT includes complex rehabilitation manual and power wheelchairs and accessories, adaptive seating and positioning items and accessories, and other specialized equipment and accessories.

sSB308 / File No.

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311 respectively.

The bill may also result in a cost to DSS to the extent that federal law allows DSS to amend the Medicaid state plan to provide Medicaid coverage for annual wheelchair maintenance and any backup equipment.

Currently, DSS does not reimburse for such services.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

Sources:

Department of Administrative Services website sSB308 / File No.

311 11 sSB308 File No.

311 OLR Bill Analysis sSB 308 AN ACT IMPLEMENTING TASK FORCE RECOMMENDATIONS FOR WHEELCHAIR REPAIR.

SUMMARY This bill requires authorized wheelchair dealers to perform timely repairs on wheelchairs, generally within 10 calendar days, and sets several related requirements.

These requirements apply to any company in the state selling or leasing wheelchairs, including complex rehabilitation technology (CRT) wheelchairs, which are specialized, medically necessary manual or power wheelchairs that are individually configured for the user with specialized equipment that require evaluation, configuration, fitting, adjustment, programming, and long- term maintenance and repair services.

The bill requires the Department of Social Services (DSS) to adopt regulations, with the Department of Aging and Disability Services, to establish (1) penalties for violating the bill’s requirements on timely repair and (2) standards for CRT (see BACKGROUND).

The bill also allows DSS to enforce the bill’s timely repair requirements by withholding a violator’s Medicaid funding.

The bill removes wheelchairs and CRT wheelchairs from the assistive technology device requirements under a separate state law that the Department of Consumer Protection (DCP) enforces.

That law generally requires device manufacturers to repair defects within a certain time period and provide a refund or replacement if the device is sent for repair at least three times, or is out of service for at least 30 days, due to the same defect.

This existing law, from which the bill exempts wheelchairs and CRT wheelchairs, sets procedures for returning and repairing purchased and leased devices, requires disclosure before returned devices are resold, allows DCP to adopt implementing sSB308 / File No.

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311 regulations, and allows for court enforcement (CGS §§ 42-330 to 42-344).

The bill also requires the DSS commissioner to provide Medicaid coverage for annual maintenance of a Medicaid recipient’s CRT wheelchair and any backup CRT wheelchair the recipient may need during the repair.

She must provide this coverage to the extent federal law allows and amend the Medicaid state plan if needed to implement these provisions.

Lastly, the bill prohibits the DSS commissioner from requiring (1) a new prescription to purchase or repair CRT, including a CRT wheelchair, unless the original prescription is more than five years old or (2) prior authorization for timely repair of a CRT wheelchair, if the original prescription was written within the prior five years.

EFFECTIVE DATE:

October 1, 2024 TIMELY REPAIR AND RELATED REQUIREMENTS The bill requires an authorized wheelchair dealer to timely repair a wheelchair it sold or leased in the state.

Under the bill, a “wheelchair” is a manual or motorized wheeled device that enhances a person’s mobility or positioning and includes a CRT wheelchair.

A repair is timely if it is completed as soon as practicable and within 10 calendar days after a consumer request, as long as the consumer makes the wheelchair available and gets any necessary prior approval from an insurer.

The bill applies to consumers who buy or lease a wheelchair, regardless of ifthe consumer or private or public health insurance funds it.

The bill requires authorized wheelchair dealers who sell or lease CRT wheelchairs to provide service and timely repair at a consumer’s home upon request.

The bill also requires authorized wheelchair dealers to maintain a phone line for consumer repair requests.

The phone line must be accessible each business day and able to record messages.

The bill requires dealers to respond to repair requests within one business day after the request and maintain a sufficient supply of parts to timely sSB308 / File No.

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311 repair wheelchairs.

The bill allows authorized wheelchair dealers to assess (1) reasonable fees for timely wheelchair repair when the warranty has expired and (2) an additional surcharge for repairing a wheelchair that is not functional due to abuse, neglect, unauthorized modification, or alteration.

ENFORCEMENT The bill requires DSS to set penalties in regulations for violating the bill’s timely repair requirements.

Under the bill, following notice and an opportunity for a hearing under the Uniform Administrative Procedure Act, DSS may reduce or withhold Medicaid funding for any authorized CRT supplier or wheelchair dealer who sells or leases wheelchairs to Medicaid recipients for violating the bill’s timely repair requirements, regardless of whether the violation involved a wheelchair purchased, leased, or repaired under the Medicaid program.

For violations involving wheelchairs sold, leased, or repaired outside of the Medicaid program, the bill authorizes the DSS commissioner to reduce or withhold Medicaid funding under any future Medicaid contract for wheelchair purchase, lease, or repair with the supplier or dealer.

BACKGROUND Complex Rehabilitation Technology (CRT) CRT includes products classified as durable medical equipment in the Medicare program as of January 1, 2013, that are individually configuredandmedically necessary forpeople tomeettheirspecific and unique medical, physical, and functional needs and capacities for basic and instrumental activities of daily living.

CRT includes complex rehabilitation manual and power wheelchairs and accessories, adaptive seating and positioning items and accessories, and other specialized equipment and accessories (e.g., standing frames and gait trainers).

COMMITTEE ACTION Human Services Committee Joint Favorable Substitute Yea 20 Nay 2 (03/19/2024) sSB308 / File No.

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