BILL ANALYSIS Ó
AB 582
Page 1
ASSEMBLY THIRD READING
AB 582 (Chesbro)
As Amended May 24, 2013
Majority vote
HEALTH 19-0 APPROPRIATIONS 16-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Gatto, Harkey, Bigelow, |
| |Atkins, Bonilla, Bonta, | |Bocanegra, Bradford, Ian |
| |Chesbro, Gomez, Roger | |Calderon, Campos, Eggman, |
| |Hernández, Bocanegra, | |Gomez, Hall, Ammiano, |
| |Maienschein, Mansoor, | |Linder, Pan, Quirk, |
| |Mitchell, Nazarian, | |Wagner, Weber |
| |Nestande, | | |
| |V. Manuel Pérez, Wagner, | | |
| |Wieckowski, Wilk | | |
| | | | |
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SUMMARY : Establishes, until January 1, 2019, complex
rehabilitation technology (CRT), such as power wheelchairs,
specialized wheelchair electronics, and nonstandard manual
wheelchairs as a separate benefit, instead of a component of the
durable medical equipment (DME) benefit in the Medi-Cal program.
Specifically, this bill :
1)Revises the definition of custom rehabilitation equipment by
renaming it CRT and establishes a separate category of
Medi-Cal benefit.
2)Requires CRT providers to be enrolled as a provider in the
Medi-Cal program, meet the supplier and quality standards
established for a DME supplier, be accredited by a recognized
accrediting organization as a supplier of CRT, employ or
contract with at least one qualified rehabilitation technology
professional for each distribution location, have the
qualified rehabilitation technology professional physically
present for the evaluation and determination of the CRT
provided, maintain a reasonable supply of parts, adequate
physical facilities, and qualified service or repair
technicians, and provide patients with prompt services and
repair for all CRT supplied.
3)Requires reimbursement for CRT to be subject to the prior
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authorization process, obtained through a treatment
authorization request and subject to utilization controls.
4)Requires reimbursement by Medi-Cal managed care plans to be
consistent with the provisions of this bill as specified.
5)Provides that it is the intent of the Legislature to provide
the support necessary for patients with CRT needs to stay in
their homes or community settings, prevent avoidable
institutionalization, reduce secondary medical complications,
ensure adequate access, recognize the value of preventive and
specialized services in the treatment of complex needs
patients, establish or improve safeguards related to the
delivery of CRT, and ensure cost efficiency in the provision
of CRT.
6)Sunsets the provisions of this bill on January 1, 2019.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, unknown costs and/or savings, likely less than
$100,000 General Fund annually. The custom equipment at issue
in this bill is very expensive but is used by only a small
percentage of Medi-Cal beneficiaries.
COMMENTS : According to the author the purpose of this bill is
to establish CRT services as a separate benefit under the
Medi-Cal program, differentiating it from other less complicated
or less costly DME and to update the current statutory
references to reflect contemporary terminology and credentialing
options. The author states that CRT, such as powered
wheelchairs and other mobility and positioning equipment is
generally more expensive and more complicated to fit, build, and
service than 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, and the degree of difficulty
involved in tailoring equipment to the individual and the need
to continually adjust and service the equipment.
The author argues that continuing this "one size fits all"
policy jeopardizes the continued availability, quality, and cost
efficiency of services throughout the state. The author points
out that most DME involves a one-time over-the-counter exchange
between a supplier and a beneficiary. In contrast, CRT involves
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an interdisciplinary team approach in which specialized staff
assesses individual patient needs, customizes or builds a
product, fits it to the individual, adjusts it on a periodic
basis, and provides any required service. The author states
that this bill is designed to enable the Department of Health
Care Services (DHCS) to treat CRT separately when evaluating
access, establishing purchasing guidelines, reviewing policies
and procedures and adopting related utilization controls,
reimbursement methodologies, and audit models. In addition,
this bill is necessary to ensure that this cost-beneficial
category of products and services receives the appropriate level
of targeted analysis when DHCS is considering benefit
reductions, rate cuts, and other program changes that will
impact the lives of those who depend upon complex rehab for
their very existence.
Supporters state that people living with disabling conditions
require customized wheelchairs to continue to live in their
homes, actively participate in their community, and
independently perform daily activities. These supporters state
that this bill would improve and protect access for anyone
covered by Medi-Cal and would protect consumers by assuring that
providers assessing and assembling CRT are certified for this
role.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000822