SB 594 — An Act providing for complex wheelchair quality assurance; and imposing duties on the Department of Human Services and the Insurance Department.

PRINTER'S NO.   602

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       SENATE BILL
                       No. 594
                                               Session of
                                                 2025

     INTRODUCED BY TARTAGLIONE, KEARNEY, STREET, FONTANA, CULVER,
        COLLETT, HAYWOOD, SCHWANK, KANE, COSTA, PENNYCUICK,
        SANTARSIERO, MILLER AND FLYNN, APRIL 9, 2025

     REFERRED TO BANKING AND INSURANCE, APRIL 9, 2025


                                    AN ACT
 1   Providing for complex wheelchair quality assurance; and imposing
 2      duties on the Department of Human Services and the Insurance
 3      Department.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6   Section 1.   Short title.
 7      This act shall be known and may be cited as the Complex
 8   Wheelchair Quality Assurance Act.
 9   Section 2.   Definitions.
10      The following words and phrases when used in this act shall
11   have the meanings given to them in this section unless the
12   context clearly indicates otherwise:
13      "Beneficiary."   An individual covered under a government
14   program.
15      "Complex wheelchair."    A wheelchair owned by a beneficiary or
16   an insured in which all of the following apply:
17          (1)   The wheelchair is originally designed, manufactured,
18      individually configured, adjusted or modified for a specific
 1      individual to meet the individual's unique medical, physical
 2      or functional needs and capacities.
 3          (2)   The wheelchair is primarily used to serve a medical,
 4      physical or functional purpose and is generally not useful to
 5      an individual in the absence of disability, illness, injury
 6      or other medical condition.
 7          (3)   The wheelchair requires certain services to ensure
 8      appropriate use, including at least one of the following:
 9                (i)    An evaluation of the features and functions to
10          the specific individual who will use the wheelchair.
11                (ii)   Configuring, fitting, programming, adjusting or
12          adapting the particular wheelchair for use by the
13          individual.
14      "Costs incurred."     The real costs of providing a semiannual
15   evaluation of a complex wheelchair, which shall include:
16          (1)   Physical checks, adjustments or use of a complex
17      wheelchair.
18          (2)   Labor costs.
19          (3)   Contacting, driving to or consulting with a
20      beneficiary regarding the appropriate use of the complex
21      wheelchair.
22      "Department."     The Department of Human Services of the
23   Commonwealth.
24      "Government program."     Either of the following:
25          (1)   The medical assistance program established under the
26      act of June 13, 1967 (P.L.31, No.21), known as the Human
27      Services Code.
28          (2)   The children's health insurance program established
29      under Article XXIII-A of the act of May 17, 1921 (P.L.682,
30      No.284), known as The Insurance Company Law of 1921.

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 1      "Health insurance policy."     As follows:
 2          (1)   An individual or group insurance policy, subscriber
 3      contract, certificate or plan offered, issued or renewed by a
 4      health insurer that provides medical or health care coverage,
 5      including emergency services.
 6          (2)   The term does not include:
 7                (i)    An accident only policy.
 8                (ii)    A credit only policy.
 9                (iii)    A long-term care or disability income policy.
10                (iv)    A specified disease policy.
11                (v)    A Medicare supplement policy.
12                (vi)    A TriCARE policy, including a Civilian Health
13          and Medical Program of the Uniformed Services (CHAMPUS)
14          supplement policy.
15                (vii)    A fixed indemnity policy.
16                (viii)    A hospital indemnity policy.
17                (ix)    A dental only policy.
18                (x)    A vision only policy.
19                (xi)    A workers' compensation policy.
20                (xii)    An automobile medical payment policy.
21                (xiii)    A homeowners' insurance policy.
22                (xiv)    Any other similar policy providing for limited
23          benefits.
24      "Health insurer."     An entity licensed by the Insurance
25   Department with accident and health authority to issue a health
26   insurance policy that is offered or governed under any of the
27   following:
28          (1)   The Insurance Company Law of 1921, including section
29      630 and Article XXIV of that act.
30          (2)   The act of December 29, 1972 (P.L.1701, No.364),

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 1      known as the Health Maintenance Organization Act.
 2             (3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
 3      corporations) or 63 (relating to professional health services
 4      plan corporations).
 5      "Insured."      An individual covered under a health insurance
 6   policy.
 7      "Service provider."      An entity with the capability of
 8   providing well-visits and which is enrolled as a Medicare
 9   durable medical equipment supplier or a Pennsylvania Medicaid
10   supplier.
11      "Well-visit."      An evaluation of a complex wheelchair and the
12   beneficiary's or insured's use of the complex wheelchair by a
13   repair technician working on behalf of a service provider, which
14   shall include the following:
15             (1)   Assessment and evaluation of the physical condition
16      of the complex wheelchair.
17             (2)   Adjustments to the condition of the complex
18      wheelchair.
19   Section 3.      Well-visit coverage.
20      A health insurance policy or government program shall provide
21   coverage for complex wheelchair maintenance and well-visits on
22   at least a semiannual basis, including costs incurred during the
23   complex wheelchair maintenance and telehealth well-visits.
24   Consistent with Federal law and regulations, government programs
25   shall honor telehealth well-visits for complex wheelchairs as
26   well-visits under the regulation of the Centers for Medicare and
27   Medicaid Services, as published in 86 Fed. Reg. 221, 64996
28   (November 19, 2021) or any regulatory successor allowing for
29   telehealth visits.
30   Section 4.      Consumer notice.

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 1      An insurer or government program shall provide an individual
 2   using a complex wheelchair annual notification of the coverage
 3   specified under section 3 from the insurer or government program
 4   providing coverage.
 5   Section 5.     Waiver.
 6      The department shall seek the appropriate Federal waiver
 7   through the Centers for Medicare and Medicaid Services necessary
 8   to carry out the provisions of this act for all Medicaid-
 9   eligible individuals who utilize a complex wheelchair.
10   Section 6.     Rules and regulations.
11      (a)   Authorization.--The department and the Insurance
12   Department may each promulgate or adopt rules and regulations as
13   may be necessary and appropriate to carry out the provisions of
14   this act.
15      (b)   Temporary regulations.--
16            (1)   In order to facilitate the prompt implementation of
17      this act, the department and the Insurance Department may
18      each issue temporary regulations. The following shall apply
19      to temporary regulations:
20                  (i)    The department and the Insurance Department must
21            issue the temporary regulations within six months of the
22            effective date of this subsection. Regulations adopted
23            after this six-month period shall be promulgated as
24            provided by statute.
25                  (ii)    Notice of the temporary regulations shall be
26            transmitted to the Legislative Reference Bureau for
27            publication in the next available issue of the
28            Pennsylvania Bulletin.
29                  (iii)    The department and the Insurance Department
30            shall each post their temporary regulations on their

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 1            publicly accessible Internet websites.
 2                  (iv)    The temporary regulations shall expire no later
 3            than two years following publication of the temporary
 4            regulations in the Pennsylvania Bulletin.
 5            (2)   The temporary regulations under paragraph (1) shall
 6      be exempt from the following:
 7                  (i)    Section 612 of the act of April 9, 1929
 8            (P.L.177, No.175), known as The Administrative Code of
 9            1929.
10                  (ii)    Sections 201, 202, 203, 204 and 205 of the act
11            of July 31, 1968 (P.L.769, No.240), referred to as the
12            Commonwealth Documents Law.
13                  (iii)    Sections 204(b) and 301(10) of the act of
14            October 15, 1980 (P.L.950, No.164), known as the
15            Commonwealth Attorneys Act.
16                  (iv)    The act of June 25, 1982 (P.L.633, No.181),
17            known as the Regulatory Review Act.
18      (c)   Contents of rules and regulations of department.--Rules
19   and regulations of the department under this section may:
20            (1)   Establish guidelines for a well-visit in accordance
21      with this act, including required components of the well-
22      visit and the competencies needed by the service provider to
23      perform the well-visit. The department shall:
24                  (i)    Provide any required changes to the guidelines
25            to insurers, service providers and individuals using
26            complex wheelchairs.
27                  (ii)    Post the guidelines, and any changes to the
28            guidelines, on the publicly accessible Internet website
29            of the department.
30            (2)   Establish a methodology for reimbursements by a

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 1      government program to a service provider regarding a complex
 2      wheelchair well-visit. The methodology must:
 3                (i)    Recognize the costs incurred to provide a well-
 4            visit under which the government program shall pay all
 5            reasonably necessary costs associated with the well-
 6            visit, subject to any copayment, coinsurance or
 7            deductible.
 8                (ii)    Include:
 9                       (A)   An explanation of how the schedule for
10                reimbursement rates was established, including the
11                factors, data and sources used to establish the
12                methodology.
13                       (B)   The elements needed to provide a well-visit.
14                       (C)   The documentation necessary for a service
15                provider to receive reimbursement for the well-visit.
16      (d)   Contents of rules and regulations by Insurance
17   Department.--Rules and regulations of the Insurance Department
18   under this section shall establish procedures regarding payments
19   for a complex wheelchair well-visit, which shall address the
20   fair reimbursement of costs incurred by a service provider in
21   providing the well-visit to an insured who owns the complex
22   wheelchair and is covered under a health insurance policy.
23      (e)   Permanent regulations.--Prior to the expiration of the
24   temporary regulations, the department and the Insurance
25   Department shall each propose for approval permanent regulations
26   as provided by statute. The proposed permanent regulations shall
27   be consistent with subsections (c) and (d) and may be the same
28   as the temporary regulations.
29   Section 7.   Review.
30      (a)   Department review.--The department shall undertake a

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 1   review of the methodology under section 6(c)(2) at least once
 2   every five years.
 3      (b)   Public review.--The department shall seek public review
 4   and comment of the methodology and reimbursement rates.
 5      (c)   Notice.--If the department intends or does not intend to
 6   make changes to the methodology or reimbursement rates during
 7   the review, the department shall transmit notice of that
 8   determination to the Legislative Reference Bureau for
 9   publication in the next available issue of the Pennsylvania
10   Bulletin.
11   Section 8.     Enforcement.
12      This act shall be enforced by the department and the
13   Insurance Department in accordance with the following:
14            (1)   The department shall:
15                  (i)    Follow the complaint procedures under 55 Pa.
16            Code § 107.4(c) (relating to procedures to assure
17            nondiscrimination of participating agencies,
18            institutions, organizations and vendors) for complaints
19            arising under this act.
20                  (ii)    Ensure that service providers receiving medical
21            assistance payments are not engaged in activities
22            prohibited by 55 Pa Code § 1101.75 (relating to provider
23            prohibited acts).
24            (2)   The Insurance Department shall enforce provisions
25      for private insurers in accordance with the act of July 22,
26      1974 (P.L.589, No.205), known as the Unfair Insurance
27      Practices Act.
28   Section 9.     Construction.
29      Nothing in this act shall be construed to limit benefits
30   otherwise available to an individual under a health insurance

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 1   policy or government program.
 2   Section 10.   Applicability.
 3      This act shall apply as follows:
 4          (1)    For health insurance policies for which either rates
 5      or forms are required to be filed with the Federal Government
 6      or the Insurance Department, this act shall apply to any
 7      policy for which a form or rate is first filed on or after
 8      the effective date of this section.
 9          (2)    For health insurance policies for which neither
10      rates nor forms are required to be filed with the Federal
11      Government or the Insurance Department, this act shall apply
12      to any policy issued or renewed on or after 180 days after
13      the effective date of this section.
14   Section 11.   Effective date.
15      This act shall take effect in 60 days.




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