BILL ANALYSIS Ó
AB 582
Page 1
Date of Hearing: May 15, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 582 (Chesbro) - As Amended: April 1, 2013
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill repeals and recasts the Medi-Cal provision governing
custom rehabilitation equipment and related technology services
by recognizing complex rehabilitation technology (CRT) as a
separate Medi-Cal benefit in both fee-for-service and managed
care. Revises the reimbursement methodology by requiring the
upper billing limit (UBL) calculation to reflect both net
acquisition cost and labor cost, as specified.
FISCAL EFFECT
Potential costs and/or savings greater than $150,000. The
custom equipment at issue in this bill is expensive but is used
by only a small percentage of Medi-Cal beneficiaries. Fiscal
changes brought about by changing the UBL calculation may be
minor on a per unit basis but could have a large impact overall.
At the same time, if complex technology equipment is better
customized for a Medi-Cal beneficiary, many other costs (repairs
to the equipment and medical complications caused by equipment
failing to work according to the recipient's individual needs)
could be avoided.
COMMENTS
1)Rationale . This bill seeks to establish CRT services as a
separate benefit under the Medi-Cal program, differentiating
it from other less complicated or costly durable medical
equipment (DME), and to update the current statutory
references to reflect contemporary terminology and
credentialing options. CRT, such as powered wheelchairs and
other mobility and positioning equipment, is generally more
expensive and more complicated to fit, build and service than
AB 582
Page 2
other DME. Medi-Cal's current inclusion of CRT within the
broad DME benefit category fails to recognize critical
differences in the population served, the level of
professional resources required, the degree of difficulty
involved in tailoring equipment to the individual, and the
need to continually adjust and service the equipment
2)Background and support . This bill is modeled after a proposal
to make similar changes to Medicare on a national level. The
proposal was developed by a broad coalition representing
providers, patients with spinal injuries, and clinicians.
According to material provided by the author, the unique
nature of CRT and needs of the individuals support the
creation of a separate benefit category. Groups including
Disability Rights California, Western Center on Law and
Poverty, and the National Multiple Sclerosis
Society-California Action Network support this bill.
CRT was included as a Medicare benefit over 40 years ago;
Medicaid followed a short time later. CRT products and
associated services include medically necessary, custom
fabricated devices that require evaluation, assembly, fitting,
adjustment, programming, and other special handling. CRT
refers to individually configured manual wheelchair systems,
power wheelchair systems, adaptive seating systems,
alternative positioning systems, and other mobility devices.
These products and services are designed to meet the specific
and unique medical, physical, and functional needs of an
individual with a primary diagnosis resulting from a
congenital disorder, progressive or degenerative neuromuscular
disease, or from certain types of injury or trauma. CRT is
used exclusively by children and adults with significant
lifetime disabilities and chronic or debilitating medical
conditions. This population consists of individuals with
diagnoses that include, Cerebral Palsy, Muscular Dystrophy,
Multiple Sclerosis (MS), Spinal Cord Injury, Amyotrophic
Lateral Sclerosis (Lou Gehrig's disease), Spina Bifida, and
other similar conditions.
3)Previous legislation . SB 728, (Negrete McLeod) Chapter 451,
Statutes of 2012, revised a provision related to determining
the maximum allowable reimbursement rate for DME in the
Medi-Cal program to use the manufacturer's suggested retail
price as documented by a catalogue showing the price on or
prior to the date of service (further reduced by a specified
AB 582
Page 3
percentage) instead of the current requirement that it be
determined by using a catalogue showing the price on June 1,
2006 as the base.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081