Amended in Assembly May 24, 2013

Amended in Assembly April 1, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 582


Introduced by Assembly Member Chesbro

February 20, 2013


An act to 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: complex rehabilitation 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 wouldbegin insert, only until January 1, 2019,end insert 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 systemsbegin delete and would require that the technology be reimbursed through a specified methodologyend delete. 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:

P2    1

SECTION 1.  

It is the intent of the Legislature to do all of the
2following:

3(a) Provide the support necessary for patients with complex
4rehabilitation technology needs to stay in their homes or
5community settings, prevent avoidable institutionalization, and
6reduce secondary medical complications.

7(b) Ensure adequate access to appropriate complex rehabilitation
8technology and support services for complex needs patients.

9(c) Recognize the value of preventive and specialized services
10in the treatment of complex needs patients.

11(d) Acknowledge the importance of the hands-on professional
12resources required for effective evaluation and configuration of
13complex rehabilitation technology.

14(e) Establish or improve safeguards related to the delivery of
15complex rehabilitation technology.

16(f) Ensure cost efficiency in the provision of complex
17rehabilitation technology.

18

SEC. 2.  

Section 14105.485 of the Welfare and Institutions
19Code
is repealed.

20

SEC. 3.  

Section 14105.485 is added to the Welfare and
21Institutions Code
, to read:

22

14105.485.  

(a) For purposes of this section, the following
23definitions apply:

24(1) “Complex rehabilitation technology” means any item, piece
25of equipment, or product system, whether modified or customized,
26that is used to increase, maintain, or improve functional capabilities
27with respect to mobility and reduce anatomical degradation and
28complications of individuals with disabilities. Complex
29rehabilitation technology includes, but is not limited to,
P3    1nonstandard manual wheelchairs, power wheelchairs,begin delete andend delete seating
2systems that are specially configured, ordered, and measured based
3on patient height, weight, and disability, specialized wheelchair
4electronics and cushions, custom bath equipment, standers, gait
5trainers, and specialized strollers.

6(2) “Complex rehabilitation technology services” includes the
7application of enabling systems designed and assembled to meet
8the needs of a patient experiencing any permanent or long-term
9loss or abnormality of physical or anatomical structure or function
10with respect to mobility. These services include, but are not limited
11to, the evaluation of the needs of a patient with a disability,
12including an assessment of the patient for the purpose of ensuring
13that the proposed equipment is appropriate; the documentation of
14medical necessity; the selection, fit, customization, maintenance,
15assembly, repair, replacement, pick up and delivery, and testing
16of equipment and parts; and the training of an assistant caregiver
17and of the patient who will use the technology or individuals who
18will assist the complex needs patient in using the technology.

19(3) “Complex rehabilitation technology provider” means a
20company or entity that complies with all of the following:

21(A) Meets the supplier and quality standards established for a
22durable medical equipment supplier under the Medicare Program
23and is enrolled as a provider in the Medi-Cal program.

24(B) Is accredited by a recognized accrediting organization as a
25supplier of complex rehabilitation technology.

26(C) Employs or contracts with at least one qualified
27rehabilitation technology professional for each distribution location.

28(D) Has the qualified rehabilitation technology professional
29physically present for the evaluation and determination of the
30complex rehabilitation technology provided.

31(E) Maintains a reasonable supply of parts, adequate physical
32facilities, and qualified service or repair technicians, and provides
33patients with prompt services and repair for all complex
34rehabilitation technology supplied.

35(4) “Qualified rehabilitation technology professional” means
36an individual to whom any one of the following applies:

37(A) The individual is a physical therapist licensed pursuant to
38Chapter 5.7 (commencing with Section 2600) of Division 2 of the
39Business and Professions Code, occupational therapist licensed
40pursuant to Chapter 5.6 (commencing with Section 2570) of
P4    1Division 2 of the Business and Professions Code, or other qualified
2health care professional approved by the department.

3(B) The individual is a registered member in good standing of
4the National Registry of Rehabilitation Technology Suppliers
5(NRRTS), and holds the designation of Certified Complex
6Rehabilitation Technology Specialist.

7(C) The individual has successfully passed the credentialing
8examination and received the credential of Assistive Technology
9Professional (ATP) from the Rehabilitation Engineering and
10Assistive Technology Society of North America (RESNA).

11(b) Complex rehabilitation technology shall be recognized as a
12separate benefit by the Medi-Cal program in both fee-for-service
13and managed care delivery systems.

14(c) Any provider of complex rehabilitation technology to a
15Medi-Cal beneficiary shall have on staff, either as an employee or
16independent contractor, or have a contractual relationship with, a
17qualified rehabilitation technology professional who is directly
18involved in determining the specific complex rehabilitation
19technology needs of the patient and is directly involved with, or
20closely supervisedbegin delete,end delete inbegin insert,end insert the final fitting and delivery of the complex
21rehabilitation technology.

22 (d) A medical provider shall conduct a physical examination of
23a patient who is a Medi-Cal beneficiary before prescribing complex
24rehabilitation technology. The medical provider shall complete a
25certificate of medical necessity, developed by the department, that
26documents the medical condition that necessitates the technology
27and verifies that the patient is capable of using the technology
28safely.

29(e) Notwithstanding Section 14133.05, complex rehabilitation
30technology shall be subject to a prior authorization process in
31which services are approved based on the medical, physical, and
32functional needs of the patient, as demonstrated in documents
33prescribed by the department. Prior authorization may be obtained
34through the treatment authorization request process set forth in
35Section 51321 of Title 22 of the California Code of Regulations.
36The department may adopt additional utilization controls for
37complex rehabilitation technology, as appropriate.

begin delete

38(f) (1) Subject to paragraph (2), complex rehabilitation
39technology shall be reimbursed through the methodology described
40in Section 14105.48.

P5    1(2) Notwithstanding Section 14105.48, the upper billing limit
2calculated pursuant to Section 51008.1 of Title 22 of the California
3Code of Regulations for complex rehabilitation technology shall
4reflect both net acquisition cost and labor cost attributable to the
5product or service, as determined from a labor index provided by
6a nationally recognized professional organization selected by the
7department based on the organization’s expertise in the provision
8of complex rehabilitation technology. If a claim for an item of
9complex rehabilitation technology contains multiple claim lines
10or multiple Healthcare Common Procedure Coding System
11(HCPCS) codes, the upper billing limit calculation shall be based
12on the sum of multiple lines or multiple codes associated with the
13completed item, with the addition of labor costs calculated as
14described in this subdivision.

15(g)

end delete

16begin insert(f)end insert Contracts initiated by the department with managed care
17plans shall be consistent with the requirements of this section.

begin insert

18(g) This section shall remain in effect only until January 1, 2019,
19and as of that date is repealed, unless a later enacted statute, that
20is enacted before January 1, 2019, deletes or extends that date.

end insert
21begin insert

begin insertSEC. end insertbegin insert4.end insert  

end insert

begin insertSection 14105.485 is added to the end insertbegin insertWelfare and
22Institutions Code
end insert
begin insert, to read:end insert

begin insert
23

begin insert14105.485.end insert  

(a) Any provider of custom rehabilitation
24equipment and custom rehabilitation technology services to a
25Medi-Cal beneficiary shall have on staff, either as an employee
26or independent contractor, or have a contractual relationship with,
27a qualified rehabilitation professional who was directly involved
28in determining the specific custom rehabilitation equipment needs
29of the patient and was directly involved with, or closely supervised,
30the final fitting and delivery of the custom rehabilitation equipment.

31(b) A medical provider shall conduct a physical examination of
32an individual before prescribing a motorized wheelchair or scooter
33for a Medi-Cal beneficiary. The medical provider shall complete
34a certificate of medical necessity, developed by the department,
35that documents the medical condition that necessitates the
36motorized wheelchair or scooter, and verifies that the patient is
37capable of using the wheelchair or scooter safely.

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

39(1) “Custom rehabilitation equipment” means any item, piece
40of equipment, or product system, whether modified or customized,
P6    1that is used to increase, maintain, or improve functional
2capabilities with respect to mobility and reduce anatomical
3degradation and complications of individuals with disabilities.
4Custom rehabilitation equipment includes, but is not limited to,
5nonstandard manual wheelchairs, power wheelchairs and seating
6systems, power scooters that are specially configured, ordered,
7and measured based on patient height, weight, and disability,
8specialized wheelchair electronics and cushions, custom bath
9equipment, standers, gait trainers, and specialized strollers.

10(2) “Custom rehabilitation technology services” means the
11application of enabling technology systems designed and assembled
12to meet the needs of a specific person experiencing any permanent
13or long-term loss or abnormality of physical or anatomical
14structure or function with respect to mobility. These services
15include, but are not limited to, the evaluation of the needs of a
16patient with a disability, including an assessment of the patient
17for the purpose of ensuring that the proposed equipment is
18appropriate, the documentation of medical necessity, the selection,
19fit, customization, maintenance, assembly, repair, replacement,
20pick up and delivery, and testing of equipment and parts, and the
21training of an assistant caregiver and of a patient who will use
22the equipment or individuals who will assist the client in using the
23equipment.

24(3) “Qualified rehabilitation professional” means an individual
25to whom any one of the following applies:

26(A) The individual is a physical therapist licensed pursuant to
27the Business and Professions Code, occupational therapist licensed
28pursuant to the Business and Professions Code, or other qualified
29health care professional approved by the department.

30(B) The individual is a registered member in good standing of
31the National Registry of Rehabilitation Technology Suppliers, or
32other credentialing organization recognized by the department.

33(C) The individual has successfully passed one of the following
34credentialing examinations administered by the Rehabilitation
35Engineering and Assistive Technology Society of North America:

36(i) The Assistive Technology Supplier examination.

37(ii) The Assistive Technology Practitioner examination.

38(iii) The Rehabilitation Engineering Technologist examination.

39(d) This section shall become operative on January 1, 2019.

end insert


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