STATE OF OKLAHOMA

2nd Session of the 53rd Legislature (2012)

SENATE BILL 1609	By:	Johnson (Constance)

AS INTRODUCED

An Act relating to Medicaid; creating the Complex Needs Patient Act; providing short title; stating Legislative intent; directing the Oklahoma Health Care Authority to provide for certain separate benefit category; directing certain coverage; defining terms; providing for codification; and providing an effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1015.4 of Title 56, unless there is created a duplication in numbering, reads as follows:
A.  This act shall be known and may be cited as the "Complex Needs Patient Act".
B.  It is the intent of the Oklahoma Legislature to:
1.  Protect complex needs patients from potential cuts to Medicaid services;
2.  Recognize the need for preventive and specialized services among complex needs patients;
3.  Recognize the need for safeguards in the delivery and provision of complex rehabilitation technologies;
4.  Allow for additional opportunities within the Medicaid program to extend to the individuals with the greatest needs; and
5.  Provide supports for complex needs patients to stay in the home setting, prevent institutionalization, and prevent hospitalizations with costly secondary complications.
C.  The Oklahoma Legislature directs the Oklahoma Health Care Authority to amend the state Medicaid plan to provide a separate benefit category within the state Medicaid program for complex needs patients.
D.  The Oklahoma Health Care Authority shall provide coverage for individually configured complex rehabilitation technology products and services for complex needs patients.  Such coverage shall take into consideration the customized nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of people with complex medical needs by:
1.  Identifying current billing codes as complex rehabilitation technology, and as needed, creating new billing codes for services and products covered for complex needs patients;
2.  Establishing specific supplier standards for companies that provide products for complex needs patients; and
3.  Making other changes as needed to protect access to products and services for people with complex medical needs.
E.  The Oklahoma Health Care Authority shall require complex needs patients receiving complex rehabilitation technologies to be evaluated by:
1.  A qualified health care professional, including, but not limited to, a physical therapist, occupational therapist, or other health care professional who performs specialty evaluations within his or her scope of practice; and
2.  A qualified complex rehabilitation technology supplier.
F.  As used in the Complex Needs Patient Act:
1.  "Complex needs patient" means an individual with a diagnosis or medical condition that results in significant physical or functional needs and capacities.  Such term shall include individuals with progressive or degenerative neuromuscular diseases or injuries or trauma which resulted in significant physical or functional needs and capacities, including, but not limited to, individuals with spinal cord injury, traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclerosis, multiple sclerosis, demyelinating disease, myelopathy, myopathy, progressive muscular atrophy, anterior horn cell disease, post-polio syndrome, cerebellar degeneration, dystonia,  Huntington's disease, spinocerebellar disease, and certain types of amputation, paralysis, or paresis that result in significant physical or functional needs and capacities;
2.  "Complex rehabilitation technology" means items classified 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 identified as medically necessary to prevent hospitalization and/or institutionalization of a complex needs patient.  Such items shall include, but not be limited to, complex rehabilitation power wheelchairs, highly configurable manual wheelchairs, adaptive seating and positioning systems, and other specialized equipment such as standing frames and gait trainers;
3.  "Individually configured" means a device has a combination of features, adjustments, or modifications specific to an individual that a supplier provides by measuring, fitting, programming, adjusting, or adapting the device as appropriate so that the device is consistent with an assessment or evaluation of the individual by a health care professional and consistent with the individual's medical condition, physical and functional needs and capacities, body size, period of need, and intended use; and
4.  "Qualified complex rehabilitation technology supplier" means a company or entity that:
a.	is accredited by a recognized accrediting organization,
b.	meets the supplier and quality standards established for durable medical equipment suppliers under the Medicare program,
c.	employs at least one complex rehabilitation technology professional for each location to analyze the needs and capacities of qualified individuals, assist in selecting appropriate covered complex rehabilitation technology items for such needs and capacities, and provide training in the use of the selected covered complex rehabilitation technology items.  Such complex rehabilitation technology professional shall be certified by the Rehabilitation Engineering and Assistive Technology Society of North America as an Assistive Technology Professional (ATP),
d.	has the complex rehabilitation technology professional physically present for the evaluation and determination of the appropriate individually configured complex rehabilitation technologies for the qualified individual with complex medical needs, and
e.	provides service and repair by qualified technicians for all complex rehabilitation technology products it sells.
SECTION 2.  This act shall become effective November 1, 2012.

53-2-2309	JM	1/19/2012 1:12:17 PM