Amended in Senate February 12, 2014

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 BillNo. 582


Introduced by Assemblybegin delete Memberend deletebegin insert Members Levine andend insert Chesbro

begin insert

(Principal coauthor: Senator Evans)

end insert

February 20, 2013


An act tobegin delete repeal and add Section 14105.485 of the Welfare and Institutions Code, relating to Medi-Cal.end deletebegin insert add Section 5451.7 to the Government Code, relating to local finance, and declaring the urgency thereof, to take effect immediately.end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 582, as amended, begin deleteChesbroend deletebegin insertLevineend insert. begin deleteMedi-Cal: complex rehabilitation technology. end deletebegin insertPalm Drive Health Care District: certificates of participation: lien.end insert

begin insert

The Local Health Care District Law authorizes health care districts in the state to provide for various forms of financing for the purpose of carrying out their duties under the law, including financing secured by public revenues.

end insert
begin insert

This bill would require that all obligations of the Palm Drive Health Care District in connection with specified certificates of participation be secured by a statutory lien on all of the revenues generated from certain dedicated parcel taxes, according to specified criteria.

end insert
begin insert

This bill would make legislative findings and declarations as to the necessity of a special statute for the Palm Drive Health Care District.

end insert
begin insert

This bill would declare that it would take effect immediately as an urgency statute.

end insert
begin delete

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.

end delete
begin delete

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.

end delete

Vote: begin deletemajority end deletebegin insert23end insert. Appropriation: no. Fiscal committee: begin deleteyes end deletebegin insertnoend insert. State-mandated local program: no.

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

P2    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 5451.7 is added to the end insertbegin insertGovernment Codeend insertbegin insert,
2to read:end insert

begin insert
3

begin insert5451.7.end insert  

(a) All obligations of the Palm Drive Health Care
4District in connection with any and all certificates of participation
5executed and delivered, or revenue bonds issued, by or on behalf
6of the district between August 15, 2005, and December 31, 2014,
7including certificates of participation executed and delivered or
P3    1revenue bonds issued before 2035 to refund the revenue bonds or
2certificates of participation, shall be secured by a statutory lien
3on all of the revenues generated from parcel taxes levied pursuant
4to Measure W, approved by the voters of the district at the general
5election held on November 2, 2004.

6(b) This lien shall arise automatically without the need for any
7action or authorization by the district or the board of directors of
8 the district. The lien shall be valid and binding from the time the
9certificates of participation are executed and delivered or the
10revenue bonds are issued.

11(c) The parcel tax revenue shall immediately be subject to this
12lien, and the lien shall immediately attach to the parcel tax revenue
13and be effective, binding, and enforceable against the district, its
14successors, purchasers of those revenues, creditors, and all others
15asserting rights therein, irrespective of whether those parties have
16notice of the lien and without the need for any physical delivery,
17recordation, filing, or further act.

end insert
18begin insert

begin insertSEC. 2.end insert  

end insert
begin insert

The Legislature finds and declares that a special law
19is necessary and that a general law cannot be made applicable
20within the meaning of Section 16 of Article IV of the California
21Constitution because of the unique circumstances regarding
22financing obligations of the Palm Drive Health Care District.

end insert
23begin insert

begin insertSEC. 3.end insert  

end insert
begin insert

This act is an urgency statute necessary for the
24immediate preservation of the public peace, health, or safety within
25the meaning of Article IV of the Constitution and shall go into
26immediate effect. The facts constituting the necessity are:

end insert
begin insert

27In order to enable the Palm Drive Health Care District to
28complete its financing, and meet its obligations to employees,
29vendors, and other creditors in a timely manner, it is necessary
30for this act to take effect immediately.

end insert
begin delete
31

SECTION 1.  

It is the intent of the Legislature to do all of the
32following:

33(a) Provide the support necessary for patients with complex
34rehabilitation technology needs to stay in their homes or
35community settings, prevent avoidable institutionalization, and
36reduce secondary medical complications.

37(b) Ensure adequate access to appropriate complex rehabilitation
38technology and support services for complex needs patients.

39(c) Recognize the value of preventive and specialized services
40in the treatment of complex needs patients.

P4    1(d) Acknowledge the importance of the hands-on professional
2resources required for effective evaluation and configuration of
3complex rehabilitation technology.

4(e) Establish or improve safeguards related to the delivery of
5complex rehabilitation technology.

6(f) Ensure cost efficiency in the provision of complex
7rehabilitation technology.

8

SEC. 2.  

Section 14105.485 of the Welfare and Institutions
9Code
is repealed.

10

SEC. 3.  

Section 14105.485 is added to the Welfare and
11Institutions Code
, to read:

12

14105.485.  

(a) For purposes of this section, the following
13definitions apply:

14(1) “Complex rehabilitation technology” means any item, piece
15of equipment, or product system, whether modified or customized,
16that is used to increase, maintain, or improve functional capabilities
17with respect to mobility and reduce anatomical degradation and
18complications of individuals with disabilities. Complex
19rehabilitation technology includes, but is not limited to,
20nonstandard manual wheelchairs, power wheelchairs, seating
21systems that are specially configured, ordered, and measured based
22on patient height, weight, and disability, specialized wheelchair
23electronics and cushions, custom bath equipment, standers, gait
24trainers, and specialized strollers.

25(2) “Complex rehabilitation technology services” includes the
26application of enabling systems designed and assembled to meet
27the needs of a patient experiencing any permanent or long-term
28loss or abnormality of physical or anatomical structure or function
29with respect to mobility. These services include, but are not limited
30to, the evaluation of the needs of a patient with a disability,
31including an assessment of the patient for the purpose of ensuring
32that the proposed equipment is appropriate; the documentation of
33medical necessity; the selection, fit, customization, maintenance,
34assembly, repair, replacement, pick up and delivery, and testing
35of equipment and parts; and the training of an assistant caregiver
36and of the patient who will use the technology or individuals who
37will assist the complex needs patient in using the technology.

38(3) “Complex rehabilitation technology provider” means a
39company or entity that complies with all of the following:

P5    1(A) Meets the supplier and quality standards established for a
2durable medical equipment supplier under the Medicare Program
3and is enrolled as a provider in the Medi-Cal program.

4(B) Is accredited by a recognized accrediting organization as a
5supplier of complex rehabilitation technology.

6(C) Employs or contracts with at least one qualified
7rehabilitation technology professional for each distribution location.

8(D) Has the qualified rehabilitation technology professional
9physically present for the evaluation and determination of the
10complex rehabilitation technology provided.

11(E) Maintains a reasonable supply of parts, adequate physical
12facilities, and qualified service or repair technicians, and provides
13patients with prompt services and repair for all complex
14rehabilitation technology supplied.

15(4) “Qualified rehabilitation technology professional” means
16an individual to whom either one of the following applies:

17(A) The individual is a registered member in good standing of
18the National Registry of Rehabilitation Technology Suppliers
19(NRRTS), and holds the designation of Certified Complex
20Rehabilitation Technology Specialist.

21(B) The individual has successfully passed the credentialing
22examination and received the credential of Assistive Technology
23Professional (ATP) from the Rehabilitation Engineering and
24Assistive Technology Society of North America (RESNA), or
25other credentialing organization recognized by the department.

26(b) Complex rehabilitation technology shall be recognized as a
27separate benefit by the Medi-Cal program in both fee-for-service
28and managed care delivery systems.

29(c) Any provider of complex rehabilitation technology to a
30Medi-Cal beneficiary shall have on staff, either as an employee or
31independent contractor, or have a contractual relationship with, a
32qualified rehabilitation technology professional who is directly
33involved in determining the specific complex rehabilitation
34technology needs of the patient and is directly involved with, or
35closely supervised in, the final fitting and delivery of the complex
36rehabilitation technology.

37 (d) A medical provider shall conduct a physical examination of
38a patient who is a Medi-Cal beneficiary before prescribing complex
39rehabilitation technology. The medical provider shall complete a
40certificate of medical necessity, developed by the department, that
P6    1documents the medical condition that necessitates the technology
2and verifies that the patient is capable of using the technology
3safely.

4(e) The department may adopt additional requirements for
5Medi-Cal coverage, including a speciality evaluation by a physical
6therapist licensed pursuant to Chapter 5.7 (commencing with
7Section 2600) of Division 2 of the Business and Professions Code,
8an occupational therapist licensed pursuant to Chapter 5.6
9(commencing with Section 2570) of Division 2 of the Business
10and Professions Code, or other licensed health care professional
11approved by the department. The licensed health professional
12performing the specialty evaluation may not have a financial
13relationship with the complex rehabilitation technology provider.

14(f) Notwithstanding Section 14133.05, complex rehabilitation
15technology shall be subject to a prior authorization process in
16which services are approved based on the medical, physical, and
17functional needs of the patient, as demonstrated in documents
18prescribed by the department. Prior authorization may be obtained
19through the treatment authorization request process set forth in
20Section 51321 of Title 22 of the California Code of Regulations.
21The department may adopt additional utilization controls for
22complex rehabilitation technology, as appropriate.

23(g) Contracts initiated by the department with managed care
24plans shall be consistent with the requirements of this section.

25(h) This section shall remain in effect only until January 1, 2019,
26and as of that date is repealed, unless a later enacted statute, that
27is enacted before January 1, 2019, deletes or extends that date.

28

SEC. 4.  

Section 14105.485 is added to the Welfare and
29Institutions Code
, to read:

30

14105.485.  

(a) Any provider of custom rehabilitation
31equipment and custom rehabilitation technology services to a
32Medi-Cal beneficiary shall have on staff, either as an employee or
33independent contractor, or have a contractual relationship with, a
34qualified rehabilitation professional who was directly involved in
35determining the specific custom rehabilitation equipment needs
36of the patient and was directly involved with, or closely supervised,
37the final fitting and delivery of the custom rehabilitation equipment.

38(b) A medical provider shall conduct a physical examination of
39an individual before prescribing a motorized wheelchair or scooter
40for a Medi-Cal beneficiary. The medical provider shall complete
P7    1a certificate of medical necessity, developed by the department,
2that documents the medical condition that necessitates the
3motorized wheelchair or scooter, and verifies that the patient is
4capable of using the wheelchair or scooter safely.

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

6(1) “Custom rehabilitation equipment” means any item, piece
7of equipment, or product system, whether modified or customized,
8that is used to increase, maintain, or improve functional capabilities
9with respect to mobility and reduce anatomical degradation and
10complications of individuals with disabilities. Custom rehabilitation
11equipment includes, but is not limited to, nonstandard manual
12wheelchairs, power wheelchairs and seating systems, power
13 scooters that are specially configured, ordered, and measured based
14on patient height, weight, and disability, specialized wheelchair
15electronics and cushions, custom bath equipment, standers, gait
16trainers, and specialized strollers.

17(2) “Custom rehabilitation technology services” means the
18application of enabling technology systems designed and assembled
19to meet the needs of a specific person experiencing any permanent
20or long-term loss or abnormality of physical or anatomical structure
21or function with respect to mobility. These services include, but
22are not limited to, the evaluation of the needs of a patient with a
23disability, including an assessment of the patient for the purpose
24of ensuring that the proposed equipment is appropriate, the
25documentation of medical necessity, the selection, fit,
26customization, maintenance, assembly, repair, replacement, pick
27up and delivery, and testing of equipment and parts, and the
28training of an assistant caregiver and of a patient who will use the
29equipment or individuals who will assist the client in using the
30equipment.

31(3) “Qualified rehabilitation professional” means an individual
32to whom any one of the following applies:

33(A) The individual is a physical therapist licensed pursuant to
34the Business and Professions Code, occupational therapist licensed
35pursuant to the Business and Professions Code, or other qualified
36health care professional approved by the department.

37(B) The individual is a registered member in good standing of
38the National Registry of Rehabilitation Technology Suppliers, or
39other credentialing organization recognized by the department.

P8    1(C) The individual has successfully passed one of the following
2credentialing examinations administered by the Rehabilitation
3Engineering and Assistive Technology Society of North America:

4(i) The Assistive Technology Supplier examination.

5(ii) The Assistive Technology Practitioner examination.

6(iii) The Rehabilitation Engineering Technologist examination.

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

end delete


O

    94