Amended in Senate July 2, 2013

Amended in Senate June 13, 2013

Amended in Assembly May 24, 2013

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 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 would, 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 appropriate, and additional requirements for Medi-Cal coverage, as specified.

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.

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, 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 either one of the following applies:

(A) 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.

(B) 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 begin delete (RESNA). end delete
begin insert (RESNA), or other credentialing organization recognized by the
department. end insert

(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) The department may adopt additional requirements for
Medi-Cal coverage, including a speciality evaluation by a physical
therapist licensed pursuant to Chapter 5.7 (commencing with
Section 2600) of Division 2 of the Business and Professions Code,
an occupational therapist licensed pursuant to Chapter 5.6
(commencing with Section 2570) of Division 2 of the Business
and Professions Code, or other licensed health care professional
approved by the department. The licensed health professional
performing the specialty evaluation may not have a financial
relationship with the complex rehabilitation begin delete technology. end delete begin insert technology
provider. end insert

(f) 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.

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

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and as of that date is repealed, unless a later enacted statute, that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

SEC. 4.  

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

14105.485.  

(a) 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) 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, 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:

(i) The Assistive Technology Supplier examination.

(ii) The Assistive Technology Practitioner examination.

(iii) The Rehabilitation Engineering Technologist examination.

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