Coverage for complex wheelchair service and repair

(215 ILCS 5/356z.84)     Sec. 356z.84. Coverage for complex wheelchair service and repair.     (a) As used in this Section:     "Complex rehabilitation technology" means a medically necessary complex wheelchair and associated accessories that is individually configured for an individual to meet specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living.     "Complex wheelchair" has the meaning given in the Complex Rehabilitation Technology Act.     "Qualified complex rehabilitation technology supplier" means a person who meets the requirements of Section 10 of the Complex Rehabilitation Technology Act.     "Repair" means the repair or replacement of a deficient, broken, or otherwise malfunctioning part, component, hardware, or software, when the deficient, broken, or otherwise malfunctioning state of such part, component, hardware, or software results in the incapacity of or otherwise diminished capacity for use of a complex rehabilitation technology.     (b) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 and that provides coverage for complex rehabilitation technology shall not require prior authorization, medical documentation, or proof of continued need to complete medically necessary repairs for consumer-owned complex rehabilitation technology unless:         (1) the repairs are covered under a manufacturer's     warranty;        (2) the cumulative cost of the repairs exceeds 75% of     the cost to replace the complex rehabilitation technology; or        (3) the complex rehabilitation technology in need of     repair is subject to replacement because the age of the complex rehabilitation technology exceeds or is within one year of the expiration of the 5-year reasonable useful life of the complex rehabilitation technology.     (c) Notwithstanding subsection (b), a Medicaid managed care plan amended, delivered, issued, or renewed on or after January 1, 2027 and that provides coverage for complex rehabilitation technology shall not require prior authorization, medical documentation, or proof of continued need to complete medically necessary repairs for consumer-owned complex rehabilitation technology under the total value of $1,500. Acceptance or denial of repairs of $1,500 or more must be made within 7 days of request of preauthorization.     Documentation of any repairs completed for consumer-owned complex rehabilitation technology shall be maintained by the qualified complex rehabilitation technology supplier conducting the repairs and must be made available to the insurer upon request.     (d) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 and that provides coverage for a complex rehabilitation technology shall provide coverage for rented complex rehabilitation technology during the time the primary complex rehabilitation technology is under repair consistent with the provisions for consumer-owned complex rehabilitation technology in subsection (b).     (e) If, after a post-service review for medical necessity, an insurer finds that any repair of an item not covered at initial issue of the complex wheelchair was not medically necessary, the insurer and owner shall be held harmless for the cost of the repair and the qualified complex rehabilitation technology supplier that conducted the repair shall be liable for the cost of repair. (Source: P.A. 104-324, eff. 1-1-26; 104-852, eff. 8-21-26.)