2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-323 - [Effective 8/7/2024] Complex rehabilitation technology - no prior authorization - metrics - report - rules - legislative declaration - definitions

(1)
The general assembly finds and declares it is in the best interests of the people of the state of Colorado to:
(a)
Continue to protect access to important technology and supporting services for eligible members;
(b)
Establish and improve current safeguards relating to the delivery, provision, and repair of medically necessary complex rehabilitation technology;
(c)
Continue to provide supports for members accessing complex rehabilitation technology to stay in the home or community setting; engage in basic activities of daily living and instrumental activities of daily living, including employment; prevent institutionalization; and prevent hospitalization and other costly secondary complications; and
(d)
Continue adequate pricing for complex rehabilitation technology for the purpose of allowing continued access to appropriate products and related services including maintenance and repair.
(2)
As used in this section, unless the context otherwise requires:
(a)
"Complex rehabilitation technology" means individually configured manual wheelchair systems, power wheelchair systems, adaptive seating systems, alternative positioning systems, standing frames, gait trainers, and specifically designated options and accessories classified as durable medical equipment that:
(I)
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, including employment, identified as medically necessary to promote mobility in the home and community or prevent hospitalization or institutionalization of the Member;
(II)
Are primarily used to serve a medical purpose and generally not useful to a person in the absence of illness or injury; and
(III)
Require certain services provided by a qualified complex rehabilitation technology provider to ensure appropriate design, configuration, and use of such items, including patient evaluation or assessment of the Member by a health-care professional, and that are consistent with the member's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
(b)
"Individually configured" means that a device has features, adjustments, or modifications specific to a Member that a qualified complex rehabilitation technology supplier provides by measuring, fitting, programming, adjusting, adapting, and maintaining the device so that the device is consistent with an assessment or evaluation of the Member by a health-care professional and consistent with the member's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
(c)
"Qualified complex rehabilitation technology professional" means an individual who is certified by the rehabilitation engineering and assistive technology society of North America or other nationally recognized accrediting organizations as an assistive technology professional.
(d)
"Qualified complex rehabilitation technology supplier" means a company or entity that:
(I)
Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology;
(II)
Meets the supplier and quality standards established for durable medical equipment suppliers under the medicare or medicaid program;
(III)
Employs at least one qualified complex rehabilitation technology professional for each location to:
(A)
Analyze the needs and capacities of members for a complex rehabilitation technology item in consultation with the evaluating clinical professionals;
(B)
Assist in selecting appropriate complex rehabilitation technology items for such needs and capacities; and
(C)
Provide the Member technology-related training in the proper use and maintenance of the selected complex rehabilitation technology items;
(IV)
Has the qualified complex rehabilitation technology professional directly involved with the assessment, and determination of the appropriate individually configured complex rehabilitation technology for the Member, with the involvement to include seeing the Member visually either in person or by any other real-time means within a reasonable time frame during the determination process.
(V)
Maintains a reasonable supply of parts, adequate physical facilities, and qualified service or repair technicians to provide members with prompt service and repair of all complex rehabilitation technology it sells or supplies; and
(VI)
Provides the Member written information at the time of sale as to how to access service and repair.
(3)
The state department shall provide a separate recognition within the state's medicaid program established pursuant to this article
5
and articles 4 and
6
of this title 25.5 for complex rehabilitation technology and shall make other required changes to protect Member access to appropriate products and services. the separate recognition must take into consideration the customized nature of complex rehabilitation technology and the broad range of related services necessary to meet the unique medical and functional needs of members and include the following:
(a)
The state department notifying the qualified rehabilitation technology suppliers concerning the parameters of the complex rehabilitation technology benefit, which benefit must include the use of qualified rehabilitation technology suppliers as well as billing procedures that specify the types of equipment identified and included in the complex rehabilitation technology benefit. The state department shall create complex rehabilitation technology benefit parameters that are easily understood by and accessible to members and qualified rehabilitation technology suppliers. The state department shall provide public notice no later than thirty days prior to a collaborative process that includes discussion of any proposed changes to the types of equipment identified and included in the complex rehabilitation technology benefit.
(b)
Adopting specific supplier standards, as described in paragraph (d) of subsection (2) of this section, for companies or entities that provide complex rehabilitation technology and restricting the provision of complex rehabilitation technology to those companies or entities that are qualified complex rehabilitation suppliers;
(c)
Ensuring that members receiving complex rehabilitation technology are evaluated or assessed, as needed, by:
(I)
A qualified health-care professional, including but not limited to a licensed physical therapist, a licensed occupational therapist, or other licensed health-care professional who has no financial relationship with the qualified complex rehabilitation technology supplier and performs specialty evaluations within his or her scope of practice; and
(II)
A qualified complex rehabilitation technology professional employed by the qualified complex rehabilitation technology supplier. The assessment and determination performed by the qualified complex rehabilitation technology professional employed by the qualified complex rehabilitation supplier shall continue to be included in the reimbursement for the purchased or rented complex rehabilitation technology;
(d)
Continuing pricing policies for complex rehabilitation technology, unless specifically prohibited by the federal centers for medicare and medicaid services, including the following:
(I)
Continuing to ensure that the reimbursement amounts for complex rehabilitation technology, repairs, and supporting clinical complex rehabilitation technology services are adequate to ensure that eligible members have access to the items, taking into account the unique needs of the members and the complexity and customization of complex rehabilitation technology. This includes developing pricing policies that ensure access to adequate and timely repairs.
(II)
Exempting complex rehabilitation technology from inclusion in competitive bidding programs or similar processes; and
(III)
Preserving the option for complex rehabilitation technology to be billed and paid for as a purchase allowing for lump sum payments for devices with a length of need of one year or greater, excluding approved crossover claims for members enrolled in medicare and medicaid; and
(e)
Making other changes as needed to protect access to complex rehabilitation technology for members.
(4)
The state department shall not require prior authorization for any repair of complex rehabilitation technology.
(5)
(a)
No later than October 1, 2023, the state board shall promulgate rules establishing repair metrics for all complex rehabilitation technology suppliers and complex rehabilitation technology professionals. At a minimum, the metrics must include requirements for repairing complex rehabilitation technology in a timely manner and the expected quality of each repair. Prior to promulgating rules pursuant to this subsection (5)(a), the state department shall engage in a stakeholder process, which process must include qualified complex rehabilitation technology professionals, qualified complex rehabilitation technology suppliers, and complex rehabilitation technology members.
(b)
Beginning January 2024, and each January thereafter, the state department shall report on the metrics developed pursuant to subsection (5)(a) of this section and compliance with the metrics as part of its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing required by section
2-7-203
.
(6)
Three years after the date the repair metric rules are established pursuant to subsection (5)(a) of this section, the state department may engage in a stakeholder process to determine the need for additional accountability of a qualified complex rehabilitation technology supplier through financial penalties, audits, or similar tools, for violations of the repair metrics rules. If a stakeholder process is convened, the process must include qualified complex rehabilitation technology professionals, qualified complex rehabilitation technology suppliers, complex rehabilitation members, and an advocacy group for persons with disabilities.
(7)
Beginning December 1, 2024, the state department shall reimburse labor costs for repairs of complex rehabilitation technology at a rate that is twenty-five percent higher for members residing in rural areas than the rate for members residing in urban areas.
Amended by 2024 Ch. 152,§ 51, eff. 8/7/2024.
Amended by 2023 Ch. 303,§ 51, eff. 8/7/2023.
Amended by 2022 Ch. 328, § 1, eff. 6/2/2022.
Added by 2014 Ch. 253, § 1, eff. 1/1/2015.
L. 2014: Entire section added, (HB 14-1211), ch. 253, p. 1008, § 1, effective 1/1/2015.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Ch. 303, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.