BILL NUMBER: AB 582 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 1, 2013
INTRODUCED BY Assembly Member Chesbro
FEBRUARY 20, 2013
An act to amend repeal and add
Section 14105.485 of the Welfare and Institutions Code, relating to
Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 582, as amended, Chesbro. Medi-Cal: custom
complex rehabilitation technology services.
technology.
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. 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.
This bill would require the department, for purposes of
establishing reimbursement rates, to recognize custom rehabilitation
technology services, as defined, as a separate benefit.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature to
do all of the following:
(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.
(b) Ensure adequate access to appropriate complex rehabilitation
technology and support services for complex needs patients.
(c) Recognize the value of preventive and specialized services in
the treatment of complex needs patients.
(d) Acknowledge the importance of the hands-on professional
resources required for effective evaluation and configuration of
complex rehabilitation technology.
(e) Establish or improve safeguards related to the delivery of
complex rehabilitation technology.
(f) Ensure cost efficiency in the provision of complex
rehabilitation technology.
SEC. 2. Section 14105.485 of the
Welfare and Institutions Code is repealed.
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.
SEC. 3. Section 14105.485 is added to the
Welfare and Institutions Code , to read:
14105.485. (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.
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.