PRINTER'S NO. 480
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
511
Session of
2023
INTRODUCED BY TARTAGLIONE, KEARNEY, FONTANA, HAYWOOD, STREET,
SANTARSIERO, MILLER, BREWSTER, COSTA, SCHWANK AND DILLON,
MARCH 15, 2023
REFERRED TO HEALTH AND HUMAN SERVICES, MARCH 15, 2023
AN ACT
Providing for complex wheelchair quality assurance; and imposing
duties on the Department of Human Services and the Insurance
Department.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Complex
Wheelchair Quality Assurance Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Beneficiary." An individual covered under a government
program.
"Complex wheelchair." A wheelchair owned by a beneficiary or
an insured in which all of the following apply:
(1) The wheelchair is originally designed, manufactured,
individually configured, adjusted or modified for a specific
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individual to meet the individual's unique medical, physical
or functional needs and capacities.
(2) The wheelchair is primarily used to serve a medical,
physical or functional purpose and is generally not useful to
an individual in the absence of disability, illness, injury
or other medical condition.
(3) The wheelchair requires certain services to ensure
appropriate use, including at least one of the following:
(i) An evaluation of the features and functions to
the specific individual who will use the wheelchair.
(ii) Configuring, fitting, programming, adjusting or
adapting the particular wheelchair for use by the
individual.
"Costs incurred." The real costs of providing a semiannual
evaluation of a complex wheelchair, which shall include:
(1) Physical checks, adjustments or use of a complex
wheelchair.
(2) Labor costs.
(3) Contacting, driving to or consulting with a
beneficiary regarding the appropriate use of the complex
wheelchair.
"Department." The Department of Human Services of the
Commonwealth.
"Government program." Either of the following:
(1) The medical assistance program established under the
act of June 13, 1967 (P.L.31, No.21), known as the Human
Services Code.
(2) The children's health insurance program established
under Article XXIII-A of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921.
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"Health insurance policy." As follows:
(1) An individual or group insurance policy, subscriber
contract, certificate or plan offered, issued or renewed by a
health insurer that provides medical or health care coverage,
including emergency services.
(2) The term does not include:
(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A TriCARE policy, including a Civilian Health
and Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A dental only policy.
(x) A vision only policy.
(xi) A workers' compensation policy.
(xii) An automobile medical payment policy.
(xiii) A homeowners' insurance policy.
(xiv) Any other similar policy providing for limited
benefits.
"Health insurer." An entity licensed by the Insurance
Department with accident and health authority to issue a health
insurance policy that is offered or governed under any of the
following:
(1) The Insurance Company Law of 1921, including section
630 and Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
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known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Insured." An individual covered under a health insurance
policy.
"Service provider." An entity with the capability of
providing well-visits and which is enrolled as a Medicare
durable medical equipment supplier or a Pennsylvania Medicaid
supplier.
"Well-visit." An evaluation of a complex wheelchair and the
beneficiary's or insured's use of the complex wheelchair by a
repair technician working on behalf of a service provider, which
shall include the following:
(1) Assessment and evaluation of the physical condition
of the complex wheelchair.
(2) Adjustments to the condition of the complex
wheelchair.
Section 3. Well-visit coverage.
A health insurance policy or government program shall provide
coverage for complex wheelchair maintenance and well-visits on
at least a semiannual basis, including costs incurred during the
complex wheelchair maintenance and telehealth well-visits.
Consistent with Federal law and regulations, government programs
shall honor telehealth well-visits for complex wheelchairs as
well-visits under the regulation of the Centers for Medicare and
Medicaid Services, as published in 86 Fed. Reg. 221, 64996
(November 19, 2021) or any regulatory successor allowing for
telehealth visits.
Section 4. Consumer notice.
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An insurer or government program shall provide an individual
using a complex wheelchair annual notification of the coverage
specified under section 3 from the insurer or government program
providing coverage.
Section 5. Waiver.
The department shall seek the appropriate Federal waiver
through the Centers for Medicare and Medicaid Services necessary
to carry out the provisions of this act for all Medicaid-
eligible individuals who utilize a complex wheelchair.
Section 6. Rules and regulations.
(a) Authorization.--The department and the Insurance
Department may each promulgate or adopt rules and regulations as
may be necessary and appropriate to carry out the provisions of
this act.
(b) Temporary regulations.--
(1) Notwithstanding any other provision of law, in order
to facilitate the prompt implementation of this act, the
department and the Insurance Department may each issue
temporary regulations. The following apply:
(i) The department and the Insurance Department must
issue the temporary regulations within six months of the
effective date of this subsection. Regulations adopted
after this six-month period shall be promulgated as
provided by statute.
(ii) Notice of the temporary regulations shall be
transmitted to the Legislative Reference Bureau for
publication in the next available issue of the
Pennsylvania Bulletin.
(iii) The department and the Insurance Department
shall each post their temporary regulations on their
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publicly accessible Internet websites.
(iv) The temporary regulations shall expire no later
than two years following publication of the temporary
regulations in the Pennsylvania Bulletin.
(2) The temporary regulations under paragraph (1) shall
be exempt from the following:
(i) Section 612 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of
1929.
(ii) Sections 201, 202, 203, 204 and 205 of the act
of July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(iii) Sections 204(b) and 301(10) of the act of
October 15, 1980 (P.L.950, No.164), known as the
Commonwealth Attorneys Act.
(iv) The act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
(c) Contents of rules and regulations of department.--Rules
and regulations of the department under this section may:
(1) Establish guidelines for a well-visit in accordance
with this act, including required components of the well-
visit and the competencies needed by the service provider to
perform the well-visit. The following apply:
(i) The department shall provide any required
changes to the guidelines to insurers, service providers
and individuals using complex wheelchairs.
(ii) The department shall post the guidelines, and
any changes to the guidelines, on the publicly accessible
Internet website of the department.
(2) Establish a methodology for reimbursements by a
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government program to a service provider regarding a complex
wheelchair well-visit. The following apply:
(i) The methodology must recognize the costs
incurred to provide a well-visit under which the
government program shall pay all reasonably necessary
costs associated with the well-visit, subject to any
copayment, coinsurance or deductible.
(ii) The methodology must include:
(A) An explanation of how the schedule for
reimbursement rates was established, including the
factors, data and sources used to establish the
methodology.
(B) The elements needed to provide a well-visit.
(C) The documentation necessary for a service
provider to receive reimbursement for the well-visit.
(d) Contents of rules and regulations by Insurance
Department.--Rules and regulations of the Insurance Department
under this section shall establish procedures regarding payments
for a complex wheelchair well-visit, which shall address the
fair reimbursement of costs incurred by a service provider in
providing the well-visit to an insured who owns the complex
wheelchair and is covered under a health insurance policy.
(e) Permanent regulations.--Prior to the expiration of the
temporary regulations, the department and the Insurance
Department shall each propose for approval permanent regulations
as provided by statute. The proposed permanent regulations shall
be consistent with subsections (c) and (d) and may be the same
as the temporary regulations.
Section 7. Review.
The department shall undertake a review of the methodology
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under section 6(c)(2) at least once every five years. The
following apply:
(1) The department shall seek public review and comment
of the methodology and reimbursement rates.
(2) If the department intends or does not intend to make
changes to the methodology or reimbursement rates during the
review, the department shall transmit notice of that
determination to the Legislative Reference Bureau for
publication in the next available issue of the Pennsylvania
Bulletin.
Section 8. Enforcement.
This act shall be enforced by the department and the
Insurance Department. The following apply:
(1) The department shall:
(i) Follow the complaint procedures under 55 Pa.
Code § 107.4(c) (relating to procedures to assure
nondiscrimination of participating agencies,
institutions, organizations and vendors) for complaints
arising under this act.
(ii) Ensure that service providers receiving medical
assistance payments are not engaged in activities
prohibited by 55 Pa Code § 1101.75 (relating to provider
prohibited acts).
(2) The Insurance Department shall enforce provisions
for private insurers in accordance with the act of July 22,
1974 (P.L.589, No.205), known as the Unfair Insurance
Practices Act.
Section 9. Construction.
Nothing in this act shall be construed to limit benefits
otherwise available to an individual under a health insurance
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policy or government program.
Section 10. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this section.
Section 11. Effective date.
This act shall take effect in 60 days.
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