NOTE: The governor signed this measure on 5/22/2014.
      
      
      HOUSE BILL 14-1211
      
      
      BY REPRESENTATIVE(S) Young, Ginal, Singer, Tyler, Duran, Exum,
      Fields, Kraft-Tharp, Labuda, Lee, May, Melton, Mitsch Bush, Primavera,
      Rosenthal, Schafer, Vigil, Williams;
      also SENATOR(S) Tochtrop, Aguilar, Guzman, Heath, Kefalas, Newell,
      Nicholson, Steadman.
      
      
      Concerning ensuring access to quality complex rehabilitation
           technology in the medicaid program, and, in connection
           therewith, making and reducing appropriations.
      
      
     Be it enacted by the General Assembly of the State of Colorado:
     
          SECTION 1.  In Colorado Revised Statutes, add 25.5-5-323 as
     follows:
     
          25.5-5-323.  Complex rehabilitation technology - 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 clients;
     
          (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 clients 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 client;
     
          (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 client by a health care
     professional, and that are consistent with the client'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 client 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 client by a health care
     professional and consistent with the client'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 clients 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 client 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 client, with such involvement
     to include seeing the client 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 clients with prompt service and repair of all complex
     rehabilitation technology it sells or supplies; and
     
          (VI)  Provides the client 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 under
     articles 4, 5, and 6 of this title for complex rehabilitation
     technology and shall make other required changes to protect
     client access to appropriate products and services. Such 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 clients 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 clients 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 clients 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 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 qualified clients have access to the items, taking
     into account the unique needs of the clients 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 clients
     enrolled in medicare and medicaid; and
     
          (e)  Making other changes as needed to protect access to
     complex rehabilitation technology for clients.
     
          SECTION 2.  In Colorado Revised Statutes, 25.5-5-404, add (1) (v)
     as follows:
     
          25.5-5-404.  Selection of managed care entities. (1)  In addition to
     any other criteria specified in rule by the state board, in order to participate
     in the managed care system, the MCE shall comply with specific criteria
     that include, but are not limited to, the following:
     
          (v)  The MCE shall comply with provisions relating to
     complex rehabilitation technology established by the state
     department pursuant to section 25.5-5-323. This provision does not
     apply to article 8 of this title.
     
          SECTION 3.  Appropriation - adjustments to 2014 long bill.
     (1)  For the implementation of this act, the general fund appropriation made
     in the annual general appropriation act to the controlled maintenance trust
     fund created in section 24-75-302.5 (2) (a), Colorado Revised Statutes, for
     the fiscal year beginning July 1, 2014, is decreased by $16,533.
     
          (2)  In addition to any other appropriation, there is hereby
     appropriated to the department of health care policy and financing, for the
     fiscal year beginning July 1, 2014, the sum of $51,133, or so much thereof
     as may be necessary, comprised of $16,533 from the general fund and
     $34,600 from federal funds, to be allocated to the executive director's office
     for the implementation of this act as follows:
     
          (a)   $15,000, comprised of $7,500 general fund and $7,500 federal
     funds, for general administration, general professional services and special
     projects;
     
          (b) $25,200, comprised of $6,300 general fund and $18,900 federal
     funds, for information technology contracts and projects, Medicaid
     management information system maintenance and projects; and
     
          (c)   $10,933, comprised of $2,733 general fund and $8,200 federal
     funds, for utilization and quality review contracts, professional services
     contracts.
     
          SECTION 4.  Act subject to petition - effective date. This act
     takes effect January 1, 2015; except that, if a referendum petition is filed
     pursuant to section 1 (3) of article V of the state constitution against this act
     or an item, section, or part of this act within the ninety-day period after final
     adjournment of the general assembly, then the act, item, section, or part will
     not take effect unless approved by the people at the general election to be
     held in November 2014 and, in such case, will take effect on January 1,
     2015, or on the date of the official declaration of the vote thereon by the
     governor, whichever is later.
     
     
     
     
     ________________________________________________________
     Mark Ferrandino                         Morgan Carroll
     SPEAKER OF THE HOUSE                      PRESIDENT OF
     OF REPRESENTATIVES                          THE SENATE
     
     
     
     
     
     
     ____________________________  ____________________________
     Marilyn Eddins                       Cindi L. Markwell
     CHIEF CLERK OF THE HOUSE                  SECRETARY OF
     OF REPRESENTATIVES                          THE SENATE
     
     
     
     
                 APPROVED________________________________________
     
     
     
     
     
                                   _________________________________________
                                   John W. Hickenlooper
                                   GOVERNOR OF THE STATE OF COLORADO