(1) The authority shall establish a separate recognition for individually configured, complex rehabilitation technology products and services for complex needs patients with the medical assistance program. This separate recognition shall:
(a) Establish a budget and services category separate from other categories, such as durable medical equipment and supplies;
(b) 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; and
(c) Establish standards for the purchase of complex rehabilitation technology exclusively from qualified complex rehabilitation technology suppliers.
(2) The authority shall require complex needs patients receiving complex rehabilitation technology to be evaluated by:
(a) A licensed health care provider who performs specialty evaluations within his or her scope of practice, including a physical therapist licensed under chapter
18.74 RCW and an occupational therapist licensed under chapter
18.59 RCW, and has no financial relationship with the qualified complex rehabilitation technology supplier; and
(b) A qualified complex rehabilitation technology professional, as identified in subsection (3)(d)(iii) of this section.
(3) As used in this section:
(a) "Complex needs patient" means an individual with a diagnosis or medical condition that results in significant physical or functional needs and capacities. "Complex needs patient" does not negate the requirement that an individual meet medical necessity requirements under authority rules to qualify for receiving a complex rehabilitation product.
(b) "Complex rehabilitation technology" means wheelchairs and seating systems classified as durable medical equipment within the medicare program as of January 1, 2013, 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 identified as medically necessary to prevent hospitalization or institutionalization of a complex needs patient;
(ii) Are primarily used to serve a medical purpose and generally not useful to a person in the absence of an illness or injury; and
(iii) Require certain services to allow for appropriate design, configuration, and use of such item, including patient evaluation and equipment fitting and configuration.
(c) "Individually configured" means a device has a combination of features, adjustments, or modifications specific to a complex needs patient that a qualified complex rehabilitation technology 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 complex needs patient by a health care professional and consistent with the complex needs patient's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
(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 program;
(iii) For each site that it operates, employs at least one complex rehabilitation technology professional, who has been certified by the rehabilitation engineering and assistive technology society of North America as an assistive technology professional, to analyze the needs and capacities of complex needs patients, 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;
(iv) Has the complex rehabilitation technology professional physically present for the evaluation and determination of the appropriate individually configured complex rehabilitation technologies for the complex needs patient;
(v) Provides service and repairs by qualified technicians for all complex rehabilitation technology products it sells; and
(vi) Provides written information to the complex needs patient at the time of delivery about how the individual may receive service and repair.
