Amended in Assembly April 1, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 582

Introduced by Assembly Member Chesbro

February 20, 2013

An act to begin delete amend end delete begin insert repeal and add end insert Section 14105.485 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 582, as amended, Chesbro. Medi-Cal: begin delete custom end delete begin insert complex end insert rehabilitation begin delete technology services. end delete begin insert technology. end insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires the department to establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment and requires the list to be published in provider manuals. begin insert Existing law requires a provider of custom rehabilitation equipment and custom rehabilitation technology services, as defined, to have a qualified rehabilitation professional on staff, as prescribed, and requires a medical provider to conduct a physical examination of an individual before prescribing a motorized wheelchair or scooter for a Medi-Cal beneficiary. end insert

begin delete

This bill would require the department, for purposes of establishing reimbursement rates, to recognize custom rehabilitation technology services, as defined, as a separate benefit.

end delete begin insert

This bill would recast these provisions to apply to complex rehabilitation technology, as defined. The bill would require that complex rehabilitation technology be recognized as a separate benefit by the Medi-Cal program in both fee-for-service and managed care delivery systems and would require that the technology be reimbursed through a specified methodology. The bill would require complex rehabilitation technology be subject to a prior authorization process, as specified, and would authorize the department to adopt additional utilization controls, as appropriate.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert It is the intent of the Legislature to do all of the
following: end insert

begin insert

(a) Provide the support necessary for patients with complex
rehabilitation technology needs to stay in their homes or
community settings, prevent avoidable institutionalization, and
reduce secondary medical complications.

end insert begin insert

(b) Ensure adequate access to appropriate complex
rehabilitation technology and support services for complex needs
patients.

end insert begin insert

(c) Recognize the value of preventive and specialized services
in the treatment of complex needs patients.

end insert begin insert

(d) Acknowledge the importance of the hands-on professional
resources required for effective evaluation and configuration of
complex rehabilitation technology.

end insert begin insert

(e) Establish or improve safeguards related to the delivery of
complex rehabilitation technology.

end insert begin insert

(f) Ensure cost efficiency in the provision of complex
rehabilitation technology.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14105.485 of the end insert begin insert Welfare and Institutions Code end insert
begin insert is repealed. end insert

begin delete

14105.485.  

(a) Commencing July 1, 2006, any provider of
custom rehabilitation equipment and custom rehabilitation
technology services to a Medi-Cal beneficiary shall have on staff,
either as an employee or independent contractor, or have a
contractual relationship with, a qualified rehabilitation professional
who was directly involved in determining the specific custom
rehabilitation equipment needs of the patient and was directly
involved with, or closely supervised, the final fitting and delivery
of the custom rehabilitation equipment.

(b) Commencing January 1, 2006, a medical provider shall
conduct a physical examination of an individual before prescribing
a motorized wheelchair or scooter for a Medi-Cal beneficiary. The
medical provider shall complete a certificate of medical necessity,
developed by the department, that documents the medical condition
that necessitates the motorized wheelchair or scooter, and verifies
that the patient is capable of using the wheelchair or scooter safely.

(c) For purposes of this section, the following definitions apply:

(1) “Custom rehabilitation equipment” means any item, piece
of equipment, or product system, whether modified or customized,
that is used to increase, maintain, or improve functional capabilities
with respect to mobility and reduce anatomical degradation and
complications of individuals with disabilities. Custom rehabilitation
equipment includes, but is not limited to, nonstandard manual
wheelchairs, power wheelchairs and seating systems, power
scooters that are specially configured, ordered, and measured based
on patient height, weight, and disability, specialized wheelchair
electronics and cushions, custom bath equipment, standers, gait
trainers, and specialized strollers.

(2) “Custom rehabilitation technology services” means the
application of enabling technology systems designed and assembled
to meet the needs of a specific person experiencing any permanent
or long-term loss or abnormality of physical or anatomical structure
or function with respect to mobility. These services include, but
are not limited to, the evaluation of the needs of a patient with a
disability, including an assessment of the patient for the purpose
of ensuring that the proposed equipment is appropriate, the
documentation of medical necessity, the selection, fit,
customization, maintenance, assembly, repair, replacement, pick
up and delivery, and testing of equipment and parts, and the
training of an assistant caregiver and of a patient who will use the
equipment or individuals who will assist the client in using the
equipment.

(3) “Qualified rehabilitation professional” means an individual
to whom any one of the following applies:

(A) The individual is a physical therapist licensed pursuant to
the Business and Professions Code, occupational therapist licensed
pursuant to the Business and Professions Code, or other qualified
health care professional approved by the department.

(B) The individual is a registered member in good standing of
the National Registry of Rehabilitation Technology Suppliers
(NRRTS), or other credentialing organization recognized by the
department.

(C) The individual has successfully passed one of the following
credentialing examinations administered by the Rehabilitation
Engineering and Assistive Technology Society of North America
(RESNA):

(i) The Assistive Technology Supplier examination.

(ii) The Assistive Technology Practitioner examination.

(iii) The Rehabilitation Engineering Technologist examination.

end delete

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 14105.485 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14105.485. end insert   

(a) For purposes of this section, the following
definitions apply:

(1) “Complex rehabilitation technology” means any item, piece
of equipment, or product system, whether modified or customized,
that is used to increase, maintain, or improve functional
capabilities with respect to mobility and reduce anatomical
degradation and complications of individuals with disabilities.
Complex rehabilitation technology includes, but is not limited to,
nonstandard manual wheelchairs, power wheelchairs, and seating
systems that are specially configured, ordered, and measured
based on patient height, weight, and disability, specialized
wheelchair electronics and cushions, custom bath equipment,
standers, gait trainers, and specialized strollers.

(2) “Complex rehabilitation technology services” includes the
application of enabling systems designed and assembled to meet
the needs of a patient experiencing any permanent or long-term
loss or abnormality of physical or anatomical structure or function
with respect to mobility. These services include, but are not limited
to, the evaluation of the needs of a patient with a disability,
including an assessment of the patient for the purpose of ensuring
that the proposed equipment is appropriate; the documentation of
medical necessity; the selection, fit, customization, maintenance,
assembly, repair, replacement, pick up and delivery, and testing
of equipment and parts; and the training of an assistant caregiver
and of the patient who will use the technology or individuals who
will assist the complex needs patient in using the technology.

(3) “Complex rehabilitation technology provider” means a
company or entity that complies with all of the following:

(A) Meets the supplier and quality standards established for a
durable medical equipment supplier under the Medicare Program
and is enrolled as a provider in the Medi-Cal program.

(B) Is accredited by a recognized accrediting organization as
a supplier of complex rehabilitation technology.

(C) Employs or contracts with at least one qualified
rehabilitation technology professional for each distribution
location.

(D) Has the qualified rehabilitation technology professional
physically present for the evaluation and determination of the
complex rehabilitation technology provided.

(E) Maintains a reasonable supply of parts, adequate physical
facilities, and qualified service or repair technicians, and provides
patients with prompt services and repair for all complex
rehabilitation technology supplied.

(4) “Qualified rehabilitation technology professional” means
an individual to whom any one of the following applies:

(A) The individual is a physical therapist licensed pursuant to
Chapter 5.7 (commencing with Section 2600) of Division 2 of the
Business and Professions Code, occupational therapist licensed
pursuant to Chapter 5.6 (commencing with Section 2570) of
Division 2 of the Business and Professions Code, or other qualified
health care professional approved by the department.

(B) The individual is a registered member in good standing of
the National Registry of Rehabilitation Technology Suppliers
(NRRTS), and holds the designation of Certified Complex
Rehabilitation Technology Specialist.

(C) The individual has successfully passed the credentialing
examination and received the credential of Assistive Technology
Professional (ATP) from the Rehabilitation Engineering and
Assistive Technology Society of North America (RESNA).

(b) Complex rehabilitation technology shall be recognized as
a separate benefit by the Medi-Cal program in both fee-for-service
and managed care delivery systems.

(c) Any provider of complex rehabilitation technology to a
Medi-Cal beneficiary shall have on staff, either as an employee
or independent contractor, or have a contractual relationship with,
a qualified rehabilitation technology professional who is directly
involved in determining the specific complex rehabilitation
technology needs of the patient and is directly involved with, or
closely supervised, in the final fitting and delivery of the complex
rehabilitation technology.

(d) A medical provider shall conduct a physical examination of
a patient who is a Medi-Cal beneficiary before prescribing complex
rehabilitation technology. The medical provider shall complete a
certificate of medical necessity, developed by the department, that
documents the medical condition that necessitates the technology
and verifies that the patient is capable of using the technology
safely.

(e) Notwithstanding Section 14133.05, complex rehabilitation
technology shall be subject to a prior authorization process in
which services are approved based on the medical, physical, and
functional needs of the patient, as demonstrated in documents
prescribed by the department. Prior authorization may be obtained
through the treatment authorization request process set forth in
Section 51321 of Title 22 of the California Code of Regulations.
The department may adopt additional utilization controls for
complex rehabilitation technology, as appropriate.

(f) (1) Subject to paragraph (2), complex rehabilitation
technology shall be reimbursed through the methodology described
in Section 14105.48.

(2) Notwithstanding Section 14105.48, the upper billing limit
calculated pursuant to Section 51008.1 of Title 22 of the California
Code of Regulations for complex rehabilitation technology shall
reflect both net acquisition cost and labor cost attributable to the
product or service, as determined from a labor index provided by
a nationally recognized professional organization selected by the
department based on the organization’s expertise in the provision
of complex rehabilitation technology. If a claim for an item of
complex rehabilitation technology contains multiple claim lines
or multiple Healthcare Common Procedure Coding System
(HCPCS) codes, the upper billing limit calculation shall be based
on the sum of multiple lines or multiple codes associated with the
completed item, with the addition of labor costs calculated as
described in this subdivision.

(g) Contracts initiated by the department with managed care
plans shall be consistent with the requirements of this section.

end insert

begin delete

SECTION 1.  

Section 14105.485 of the Welfare and Institutions
Code is amended to read:

14105.485.  

(a) Commencing July 1, 2006, any provider of
custom rehabilitation equipment and custom rehabilitation
technology services to a Medi-Cal beneficiary shall have on staff,
either as an employee or independent contractor, or have a
contractual relationship with, a qualified rehabilitation professional
who was directly involved in determining the specific custom
rehabilitation equipment needs of the patient and was directly
involved with, or closely supervised, the final fitting and delivery
of the custom rehabilitation equipment.

(b) Commencing January 1, 2006, a medical provider shall
conduct a physical examination of an individual before prescribing
a motorized wheelchair or scooter for a Medi-Cal beneficiary. The
medical provider shall complete a certificate of medical necessity,
developed by the department, that documents the medical condition
that necessitates the motorized wheelchair or scooter, and verifies
that the patient is capable of using the wheelchair or scooter safely.

(c) For purposes of this section, the following definitions apply:

(1) “Custom rehabilitation equipment” means any item, piece
of equipment, or product system, whether modified or customized,
that is used to increase, maintain, or improve functional capabilities
with respect to mobility and reduce anatomical degradation and
complications of individuals with disabilities. Custom rehabilitation
equipment includes, but is not limited to, nonstandard manual
wheelchairs, power wheelchairs and seating systems, power
scooters that are specially configured, ordered, and measured based
on patient height, weight, and disability, specialized wheelchair
electronics and cushions, custom bath equipment, standers, gait
trainers, and specialized strollers.

(2) “Custom rehabilitation technology services” means the
application of enabling technology systems designed and assembled
to meet the needs of a specific person experiencing any permanent
or long-term loss or abnormality of physical or anatomical structure
or function with respect to mobility. These services include, but
are not limited to, the evaluation of the needs of a patient with a
disability, including an assessment of the patient for the purpose
of ensuring that the proposed equipment is appropriate, the
documentation of medical necessity, the selection, fit,
customization, maintenance, assembly, repair, replacement, pick
up and delivery, and testing of equipment and parts, and the
training of an assistant caregiver and of a patient who will use the
equipment or individuals who will assist the client in using the
equipment.

(3) “Qualified rehabilitation professional” means an individual
to whom any one of the following applies:

(A) The individual is a physical therapist licensed pursuant to
the Business and Professions Code, occupational therapist licensed
pursuant to the Business and Professions Code, or other qualified
health care professional approved by the department.

(B) The individual is a registered member in good standing of
the National Registry of Rehabilitation Technology Suppliers
(NRRTS), or other credentialing organization recognized by the
department.

(C) The individual has successfully passed one of the following
credentialing examinations administered by the Rehabilitation
Engineering and Assistive Technology Society of North America
(RESNA):

(i) The Assistive Technology Supplier examination.

(ii) The Assistive Technology Practitioner examination.

(iii) The Rehabilitation Engineering Technologist examination.

(d) Notwithstanding Section 14105.48 or any other law, and for
purposes of establishing reimbursement rates, the department shall
recognize custom rehabilitation technology services, as defined in
paragraph (2) of subdivision (c), as a separate benefit.

end delete