Legislative Analysis
Phone: (517) 373-8080
COMPLEX REHABILITATION TECHNOLOGY
http://www.house.mi.gov/hfa
Senate Bill 449 (H-1) as reported from House committee
Analysis available at
Sponsor: Sen. Kevin Daley http://www.legislature.mi.gov
Senate Bill 450 (H-1) as reported from House committee
Sponsor: Sen. Jeff Irwin
House Committee: Health Policy
Senate Committee: Health Policy
Complete to 6-24-24 (Enacted as Public Acts 103 and 104 of 2024)
SUMMARY:
Senate Bills 449 and 450 would amend the Social Welfare Act to require the Department of
Health and Human Services (DHHS) to develop policies and rules for complex rehabilitation
technology products and services. Senate Bill 449 has the substantive provisions, and Senate
Bill 450 has definitions for terms used in those provisions.
Complex rehabilitation technology would mean an item classified in the Medicare
program as of January 1, 2020, as durable medical equipment that is individually
configured for an individual to meet his or her specific and unique medical, physical,
and functional needs and capacity for basic activities of daily living and instrumental
activities of daily living identified as medically necessary. The term would include
complex rehabilitation manual and power wheelchairs and options or accessories,
adaptive seating and positioning items and options or accessories, and other specialized
equipment such as standing frames and gait trainers and options or accessories.
The policies and rules required by the bills would have to do all of the following to take into
consideration the individually configured nature of complex rehabilitation technology and the
range of services needed to meet the unique medical and functional needs of an individual with
complex medical needs:
• Designate specific HCPCS billing codes for complex rehabilitation technology and
any appropriate new codes in the future.
• Exempt the related complex rehabilitation technology HCPCS billing codes from
inclusion in bidding, selective contracting, or similar initiative.
• Establish specific supplier standards for a company or entity that provides complex
rehabilitation technology and restrict providing that technology only to a qualified
complex rehabilitation technology supplier or, if unavailable, to an individual,
company, or entity approved by DHHS.
• Require a complex needs patient receiving a complex rehabilitation manual
wheelchair, power wheelchair, or seating component to be evaluated by the following:
o A qualified health care professional.
o A qualified complex rehabilitation technology professional. However, if a
qualified complex rehabilitation professional is not available, the following
would apply:
A qualified health care professional could perform the evaluation and
document the justification or medical necessity for the equipment and
services being prescribed.
House Fiscal Agency Page 1 of 4
A durable medical equipment supplier or individual approved by
DHHS could deliver the equipment described above under the direction
of a qualified health care professional and in coordination with a
qualified health care professional.
• Maintain payment policies and rates for complex rehabilitation technology to ensure
that payment amounts are adequate to provide complex needs patients with access to
those items, taking into account the significant resources, infrastructure, and staff
needed to appropriately provide that technology to meet the patient’s unique needs.
• Require managed care Medicaid plans to adopt the regulations and policies outlined in
the bills and include those regulations and policies in their contracts with qualified
complex rehabilitation technology suppliers.
• Make other changes as needed to protect access by complex needs patients to complex
rehabilitation technology.
Individually configured would mean that a device has a combination of sizes, features,
adjustments, or modifications that a qualified complex rehabilitation technology
supplier can alter or apply to a specific individual by measuring, fitting, programming,
adjusting, or adapting the device so it is consistent with an assessment or evaluation of
the individual by a qualified health care professional and with the individual’s medical
condition, physical and functional needs and capacities, body size, period of need, and
intended use.
HCPCS (“health care common procedure coding system”) would mean the billing
codes used by Medicare and overseen by the federal Centers for Medicare and
Medicaid Services that are based on the current procedural technology codes developed
by the American Medical Association.
Qualified complex rehabilitation technology supplier would mean either of the
following:
• A company or entity that meets all of the following:
o It is accredited by a recognized accrediting organization as a supplier
of complex rehabilitation technology.
o It is an enrolled Medicare supplier and meets the supplier and quality
standards established for durable medical equipment suppliers under
Medicare, including for complex rehabilitation technology.
o It has at least one employee for each location who is a qualified
complex rehabilitation technology professional to do the following:
Analyze the needs and capacities of the complex needs patient
in consultation with qualified health care professionals.
Participate in selecting appropriate complex rehabilitation
technology for the patient’s needs and capacities.
Provide technology-related training in the proper use of the
complex rehabilitation technology.
o It requires a qualified complex rehabilitation technology professional
to be physically present for the evaluation and determination of
appropriate complex rehabilitation technology.
o It has the capability to provide service and repair by a qualified
technician for all complex rehabilitation technology it sells.
House Fiscal Agency SBs 449 (H-1) and 450 (H-1) as reported Page 2 of 4
o At the time of delivery of complex rehabilitation technology, it
provides written information regarding how the complex needs patient
may receive service and repair.
• If a qualified complex rehabilitation technology supplier as defined above is
unavailable, a company or entity approved by DHHS.
Employee would mean an employee as defined in the Internal Revenue Code. A person
from whom an employer is required to withhold for federal income tax purposes would
be prima facie an employee. Employee would not include a contract employee.
Complex needs patient would mean an individual with a diagnosis of a medical
condition that results in significant physical impairment or functional limitation, such
as 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 impairment or
functional limitation. A complex needs patient would have to meet medical necessity
requirements to qualify for receiving complex rehabilitation technology.
Qualified health care professional would mean a health care professional licensed
under Article 15 of the Public Health Code who has no financial relationship with a
qualified complex rehabilitation technology supplier. It would include a licensed health
care professional who performs specialty evaluations within the professional’s scope
of practice. If a qualified complex rehabilitation technology supplier were owned by a
hospital, the health care professional could be employed by the hospital and work in an
inpatient or outpatient setting.
Qualified complex rehabilitation technology professional would mean either of the
following:
• An individual who is certified as an assistive technology professional by the
Rehabilitation Engineering and Assistive Technology Society of North
America or as a certified complex rehabilitation technology supplier by the
National Registry of Rehabilitation Technology Suppliers.
• If a qualified complex rehabilitation technology supplier is unavailable based
on the geographic location of the complex needs patient, an individual
approved by DHHS based on demonstrated experience, education, and
training.
Neither bill would take effect unless both bills were enacted.
Proposed MCL 400.108a (SB 450) and proposed MCL 400.108b (SB 449)
FISCAL IMPACT:
Senate Bills 449 and 450 would have a negligible fiscal impact on the state and no fiscal impact
on local units of government. For fiscal year 2023-24, any fiscal impact related to Medicaid
House Fiscal Agency SBs 449 (H-1) and 450 (H-1) as reported Page 3 of 4
reimbursements would be financed with federal and state funds at 64.94% and 35.06%,
respectively.
POSITIONS:
Representatives of the following organizations testified in support of the bills (4-18-24):
• Michigan HomeCare and Hospice Association
• CareLine Medical
• Michigan Home Health Association
• American Physical Therapy Association (APTA) Michigan
The following organizations indicated support for the bills:
• ALS Association (4-18-24)
• Michigan Medicine (4-18-24)
• National Coalition for Assistive and Rehab Technology (4-16-24)
Legislative Analyst: Rick Yuille
Fiscal Analyst: Kevin Koorstra
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations and does not constitute an official statement of legislative intent.
House Fiscal Agency SBs 449 (H-1) and 450 (H-1) as reported Page 4 of 4
Statutes affected: Substitute (H-1): 400.1, 400.119
Senate Introduced Bill: 400.1, 400.119
As Passed by the Senate: 400.1, 400.119
As Passed by the House: 400.1, 400.119
Senate Concurred Bill: 400.1, 400.119
Public Act: 400.1, 400.119
Senate Enrolled Bill: 400.1, 400.119