ARC 4444C

ARC 4444C

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rule making related to customized wheelchairs

and providing an opportunity for public comment

The Human Services Department hereby proposes to amend Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is proposed under the authority provided in Iowa Code section 249A.4.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code section 249A.4.

Purpose and Summary

These proposed amendments provide a definition of a customized wheelchair for all Medicaid members and providers. These amendments also align Iowa's Medicaid definition of a customized wheelchair with the definition for the Medicare program provided by the Centers for Medicare and Medicaid Services.

Fiscal Impact

This rule making has a fiscal impact to the State of Iowa of less than $100,000 annually or $500,000 over five years. Clearly defining a customized wheelchair will allow for standardized billing and may prevent Iowa Medicaid from paying separately for items that should have been part of standard coverage. This could result in Medicaid savings, but the impact is not expected to be significant.

Jobs Impact

After analysis and review of this rule making, no impact on jobs has been found.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).

Public Comment

Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m.on June 11, 2019. Comments should be directed to:

Public Hearing

No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)"b," an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members.

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee's meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

The following rule-making actions are proposed:

Item 1. Rescind subparagraph 78.10(2)"a"(4).

Item 2. Adopt the following new paragraph 78.10(2)"d":

d. Wheelchairs, wheelchair accessories, and wheelchair modifications are covered when they are medically necessary for mobility within the home, nursing facility, or intermediate care facility. Wheelchairs are defined as:

(1)Standard manual wheelchairs. Coverage of a standard manual wheelchair includes the following:

1.Complete set of tires/wheels and casters, any type;

2.Hand rims with or without projections;

3.Weight-specific components required by the patient-weight capacity of the wheelchair;

4.Elevating legrest, lower extension tube and upper hanger bracket;

5.Armrest (detachable, nonadjustable or adjustable) with or without arm pad;

6.Footrest (swingaway, detachable), including lower extension tube(s) and upper hanger bracket;

7.Standard size footplates;

8.Wheelchair bearings;

9.Caster fork, replacement only; and

10.All labor charges involved in the assembly of the wheelchair (including, but not limited to: front caster assembly, rear wheel assembly, ratchet assembly, wheel lock assembly, footrest assembly).

(2)Standard manual wheelchair accessories that are separately billable and require prior authorization include the following:

1.Headrest extensions;

2.One-arm drive attachments;

3.Positioning accessories;

4.Specialized skin protection seat and back cushions; and

5.Anti-rollback devices.

(3)Standard power wheelchair. Coverage of a standard power wheelchair requires prior authorization and includes the following:

1.Lap belt or safety belt;

2.Battery charger, single mode;

3.Complete set of tires/wheels and casters, any type;

4.Legrests (fixed, swingaway, or detachable non-elevation legrests with or without calf pad);

5.Footrests/foot platform (fixed, swingaway, detachable footrests or a foot platform without angle adjustment, single adjustable footplate);

6.Armrests (fixed, swingaway, detachable non-adjustable height armrests with arm pad provided);

7.Any weight-specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by patient-weight capacity of the wheelchair;

8.Any seat width and depth. For power wheelchairs with a sling/solid seat/back, the following may be billed separately:

●For standard duty, seat width and/or depth greater than 20 inches.

●For heavy duty, seat width and/or depth greater than 22 inches.

●For very heavy duty, seat width and/or depth greater than 24 inches.

●Exception: For extra heavy duty, there is no separate billing;

9.Any back width. For power wheelchairs with a sling/solid seat/back, the following may be billed separately:

●For standard duty, seat width and/or depth greater than 20 inches.

●For heavy duty, seat width and/or depth greater than 22 inches.

●For very heavy duty, seat width and/or depth greater than 24 inches.

●Exception: For extra heavy duty, there is no separate billing;

10.Non-expandable controller or standard proportional joystick (integrated or remote); and

11.All labor charges involved in the assembly of the wheelchair (including, but not limited to: front caster assembly, rear wheel assembly, ratchet assembly, wheel lock assembly, footrest assembly).

(4)Standard power wheelchair accessories that are billed separately and require a prior authorization include the following:

1.Shoulder harness/straps or chest straps/vest;

2.Elevating legrest;

3.Angle adjustable footplates;

4.Adjustable height armrests; and

5.Expandable controller or nonstandard joystick (i.e., non-proportional or mini, compact or short throw proportional, or other alternative control device).

(5)Customized items are payable with a prior authorization, in accordance with 42 CFR §414.224.

Item 3. Amend paragraph 78.10(5)"o" as follows:

o. Customized wheelchairs for members who are residents of nursing facilities, subject to the requirements of 78.10(2)"a"(4). 78.10(2)"d."

Item 4. Amend paragraph 78.28(1)"r" as follows:

r. Customized wheelchairs for members who are residents of nursing facilities, subject to the requirements of 78.10(2)"a"(4). 78.10(2)"d."