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 would,begin delete onlyend delete until January 1, 2019, 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. 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 appropriatebegin insert, and additional requirements for Medi-Cal coverage, as specifiedend insert.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
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.
Section 14105.485 of the Welfare and Institutions
19Code is repealed.
Section 14105.485 is added to the Welfare and
21Institutions Code, to read:
(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
P3 1rehabilitation technology includes, but is not limited to,
2nonstandard manual wheelchairs, power wheelchairs, seating
3systems that are specially configured, ordered, and measured based
4on patient height, weight, and disability, specialized wheelchair
5electronics and cushions,
custom bath equipment, standers, gait
6trainers, and specialized strollers.
7(2) “Complex rehabilitation technology services” includes the
8application of enabling systems designed and assembled to meet
9the needs of a patient experiencing any permanent or long-term
10loss or abnormality of physical or anatomical structure or function
11with respect to mobility. These services include, but are not limited
12to, the evaluation of the needs of a patient with a disability,
13including an assessment of the patient for the purpose of ensuring
14that the proposed equipment is appropriate; the documentation of
15medical necessity; the selection, fit, customization, maintenance,
16assembly, repair, replacement, pick up and delivery, and testing
17of equipment and parts; and the training of an assistant caregiver
18and of the patient who will use the technology or individuals
who
19will assist the complex needs patient in using the technology.
20(3) “Complex rehabilitation technology provider” means a
21company or entity that complies with all of the following:
22(A) Meets the supplier and quality standards established for a
23durable medical equipment supplier under the Medicare Program
24and is enrolled as a provider in the Medi-Cal program.
25(B) Is accredited by a recognized accrediting organization as a
26supplier of complex rehabilitation technology.
27(C) Employs or contracts with at least one qualified
28rehabilitation technology professional for each distribution location.
29(D) Has the
qualified rehabilitation technology professional
30physically present for the evaluation and determination of the
31complex rehabilitation technology provided.
32(E) Maintains a reasonable supply of parts, adequate physical
33facilities, and qualified service or repair technicians, and provides
34patients with prompt services and repair for all complex
35rehabilitation technology supplied.
36(4) “Qualified rehabilitation technology professional” means
37an individual to whombegin delete anyend deletebegin insert eitherend insert one of the following applies:
38(A) The individual is a physical therapist licensed pursuant to
39Chapter 5.7 (commencing with Section 2600) of Division 2 of the
40Business and Professions Code,
occupational therapist licensed
P4 1pursuant to Chapter 5.6 (commencing with Section 2570) of
2Division 2 of the Business and Professions Code, or other qualified
3health care professional approved by the department.
4(B)
end delete
5begin insert(A)end insert The individual is a registered member in good standing of
6the National Registry of Rehabilitation Technology Suppliers
7(NRRTS), and holds the designation of Certified Complex
8Rehabilitation Technology Specialist.
9(C)
end delete
10begin insert(B)end insert The individual has successfully passed the credentialing
11examination and received the credential of Assistive Technology
12Professional (ATP) from the Rehabilitation Engineering and
13Assistive Technology Society of North America (RESNA).
14(b) Complex rehabilitation technology shall be recognized as a
15separate benefit by the Medi-Cal program in both fee-for-service
16and managed care delivery systems.
17(c) Any provider of complex rehabilitation technology to a
18Medi-Cal beneficiary shall have on staff, either as an employee or
19independent contractor, or have a contractual relationship with, a
20qualified rehabilitation technology professional who is directly
21involved in determining the specific complex rehabilitation
22technology needs of the patient and is directly involved with, or
23closely
supervised in, the final fitting and delivery of the complex
24rehabilitation technology.
25 (d) A medical provider shall conduct a physical examination of
26a patient who is a Medi-Cal beneficiary before prescribing complex
27rehabilitation technology. The medical provider shall complete a
28certificate of medical necessity, developed by the department, that
29documents the medical condition that necessitates the technology
30and verifies that the patient is capable of using the technology
31safely.
32(e) The department may adopt additional requirements for
33Medi-Cal coverage, including a speciality evaluation by a physical
34therapist licensed pursuant to Chapter 5.7 (commencing with
35Section 2600) of Division 2 of the Business and Professions Code,
36an
occupational therapist licensed pursuant to Chapter 5.6
37(commencing with Section 2570) of Division 2 of the Business and
38Professions Code, or other licensed health care professional
39approved by the department. The licensed health professional
P5 1performing the specialty evaluation may not have a financial
2relationship with the complex rehabilitation technology.
3(e)
end delete
4begin insert(f)end insert Notwithstanding Section 14133.05, complex rehabilitation
5technology shall be subject to a prior authorization process in
6which services are approved based on the medical, physical, and
7functional needs of the patient, as demonstrated in documents
8prescribed by the department. Prior authorization
may be obtained
9through the treatment authorization request process set forth in
10Section 51321 of Title 22 of the California Code of Regulations.
11The department may adopt additional utilization controls for
12complex rehabilitation technology, as appropriate.
13(f)
end delete
14begin insert(g)end insert Contracts initiated by the department with managed care
15plans shall be consistent with the requirements of this section.
16(g)
end delete
17begin insert(h)end insert This section shall remain in effect only until January 1, 2019,
18and as of that date is repealed, unless a later enacted statute, that
19is enacted before January 1, 2019, deletes or extends that date.
Section 14105.485 is added to the Welfare and
21Institutions Code, to read:
(a) Any provider of custom rehabilitation
23equipment and custom rehabilitation technology services to a
24Medi-Cal beneficiary shall have on staff, either as an employee or
25independent contractor, or have a contractual relationship with, a
26qualified rehabilitation professional who was directly involved in
27determining the specific custom rehabilitation equipment needs
28of the patient and was directly involved with, or closely supervised,
29the final fitting and delivery of the custom rehabilitation equipment.
30(b) A medical provider shall conduct a physical examination of
31an individual before prescribing a motorized wheelchair or scooter
32for a Medi-Cal beneficiary. The
medical provider shall complete
33a certificate of medical necessity, developed by the department,
34that documents the medical condition that necessitates the
35motorized wheelchair or scooter, and verifies that the patient is
36capable of using the wheelchair or scooter safely.
37(c) For purposes of this section, the following definitions apply:
38(1) “Custom rehabilitation equipment” means any item, piece
39of equipment, or product system, whether modified or customized,
40that is used to increase, maintain, or improve functional capabilities
P6 1with respect to mobility and reduce anatomical degradation and
2complications of individuals with disabilities. Custom rehabilitation
3equipment includes, but is not limited to, nonstandard manual
4wheelchairs, power wheelchairs and seating systems, power
5
scooters that are specially configured, ordered, and measured based
6on patient height, weight, and disability, specialized wheelchair
7electronics and cushions, custom bath equipment, standers, gait
8trainers, and specialized strollers.
9(2) “Custom rehabilitation technology services” means the
10application of enabling technology systems designed and assembled
11to meet the needs of a specific person experiencing any permanent
12or long-term loss or abnormality of physical or anatomical structure
13or function with respect to mobility. These services include, but
14are not limited to, the evaluation of the needs of a patient with a
15disability, including an assessment of the patient for the purpose
16of ensuring that the proposed equipment is appropriate, the
17documentation of medical necessity, the selection, fit,
18customization, maintenance, assembly, repair,
replacement, pick
19up and delivery, and testing of equipment and parts, and the
20training of an assistant caregiver and of a patient who will use the
21equipment or individuals who will assist the client in using the
22equipment.
23(3) “Qualified rehabilitation professional” means an individual
24to whom any one of the following applies:
25(A) The individual is a physical therapist licensed pursuant to
26the Business and Professions Code, occupational therapist licensed
27pursuant to the Business and Professions Code, or other qualified
28health care professional approved by the department.
29(B) The individual is a registered member in good standing of
30the National Registry of Rehabilitation Technology Suppliers, or
31other
credentialing organization recognized by the department.
32(C) The individual has successfully passed one of the following
33credentialing examinations administered by the Rehabilitation
34Engineering and Assistive Technology Society of North America:
35(i) The Assistive Technology Supplier examination.
36(ii) The Assistive Technology Practitioner examination.
37(iii) The Rehabilitation Engineering Technologist examination.
38(d) This section shall become operative on January 1, 2019.
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