2023 - 2024 LEGISLATURE
LRB-4271/1
JPC:cdc&amn
2023 ASSEMBLY BILL 416
September 19, 2023 - Introduced by Representatives PLUMER, SPIROS, ROZAR,
NOVAK, EDMING, BROOKS, MAGNAFICI, BEHNKE, BRANDTJEN, DONOVAN, GOEBEN,
MURPHY, O'CONNOR and MURSAU, cosponsored by Senators FELZKOWSKI,
TESTIN, BALLWEG, COWLES, NASS, FEYEN, MARKLEIN, STAFSHOLT and TAYLOR.
Referred to Committee on Insurance.
1 AN ACT to amend 49.45 (9r) (e) (intro.); and to create 49.45 (9r) (dm) of the
2 statutes; relating to: repair of complex rehabilitation technology under the
3 Medical Assistance program.
Analysis by the Legislative Reference Bureau
Under current law, the Department of Health Services is required to
promulgate rules that establish which medical supplies and equipment are covered
by Medical Assistance and under what conditions they will be reimbursed. This bill
prohibits DHS from requiring a prescription and prior authorization before
reimbursing a provider for the repair of complex rehabilitation technology if the
complex rehabilitation technology was previously prescribed and reimbursed under
Medical Assistance, unless the complex rehabilitation technology is intended for use
by an individual who is enrolled in a managed care organization. Under current law,
“complex rehabilitation technology” is defined to mean items classified within
Medicare 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. The Medical Assistance program is a joint
federal and state program administered by DHS that provides health services to
individuals who have limited financial resources.
 2023 - 2024 Legislature -2- LRB-4271/1
JPC:cdc&amn
ASSEMBLY BILL 416
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
1 SECTION 1. 49.45 (9r) (dm) of the statutes is created to read:
2 49.45 (9r) (dm) The department may not require a prescription or prior
3 authorization to reimburse a provider for the repair of complex rehabilitation
4 technology if the complex rehabilitation technology has been prescribed and
5 reimbursed as provided in this subsection. This paragraph does not apply to the
6 repair of complex rehabilitation technology if the complex rehabilitation technology
7 is intended for use by an individual who is enrolled in a managed care organization.
8 SECTION 2. 49.45 (9r) (e) (intro.) of the statutes is amended to read:
9 49.45 (9r) (e) (intro.) The Except as provided in par. (dm), the department shall,
10 consistent with this subsection and without imposing any additional requirements
11 or restrictions under this subsection, reimburse a provider for a complex
12 rehabilitation technology with prior authorization when prescribed by a physician,
13 medically necessary, and used by a recipient of Medical Assistance who is a resident
14 of a nursing home if the complex rehabilitation technology will do any of the
15 following:
16 (END)


Statutes affected:
Bill Text: 49.45(9r)(e)(intro.), 49.45