SB 605

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.