BILL ANALYSIS Ó
COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 582
AUTHOR: Chesbro
AMENDED: June 13, 2013
HEARING DATE: June 26, 2013
CONSULTANT: Bain
SUBJECT : Medi-Cal: complex rehabilitation technology.
SUMMARY : Renames, for purposes of the Medi-Cal program, "custom
rehabilitation equipment" as "custom rehabilitation technology".
Defines a "complex rehabilitation technology provider" and
establishes requirements for these providers, including
requiring prompt services and repair for all custom
rehabilitation technology supplied by the provider. Requires
custom rehabilitation technology to be recognized as a separate
benefit by the Medi-Cal program in both fee-for-service and
managed care delivery systems. Sunsets the provisions of this
bill on January 1, 2019.
Existing law:
1.Requires any provider of custom rehabilitation equipment (CRE)
and custom rehabilitation technology services (CRTS) to a
Medi-Cal beneficiary to have on staff, either as an employee
or independent contractor, or have a contractual relationship
with, a qualified rehabilitation professional (QRP) 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 CRE.
2.Requires a medical provider to conduct a physical examination
of an individual before prescribing a motorized wheelchair or
scooter for a Medi-Cal beneficiary. Requires a medical
provider to complete a certificate of medical necessity,
developed by the Department of Health Care Services (DHCS)
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.
3.Defines CRE as 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
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complications of individuals with disabilities. CRE 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.
4.Defines CRTS as 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.
5.Defines a "qualified rehabilitation professional" (QRP) as an
individual to whom any one of the following applies:
a. The individual is a physical therapist (PT),
occupational therapist (OT), or other qualified health
care professional approved by DHCS;
b. The individual is a registered member in good
standing of the National Registry of Rehabilitation
Technology Suppliers (NRRTS), or other credentialing
organization recognized by DHCS; and,
c. The individual has successfully passed one of
the following credentialing examinations administered
by the Rehabilitation Engineering and Assistive
Technology Society of North America (RESNA):
i. The Assistive Technology Supplier
examination.
ii. The Assistive Technology
Practitioner examination.
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iii. The Rehabilitation Engineering
Technologist examination.
This bill:
1.Changes the name of CRE to "custom rehabilitation technology"
(CRT) and deletes specially configured, ordered and measured
power scooters from the new definition.
2.Requires CRT to be recognized as a separate benefit by the
Medi-Cal program in both fee-for-service and managed care
delivery systems. Requires contracts initiated by DHCS with
managed care plans to be consistent with the requirements of
this bill.
3.Requires CRT to be subject to the Medi-Cal 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 DHCS. Permits prior authorization
to be obtained through the treatment authorization request
(TAR) process set forth in regulation. Permits DHCS to adopt
additional utilization controls for CRT, as appropriate.
4.Deletes from the definition of a QRTP a PT, OT or other
qualified health care professional approved by DHCS, and
changes the criteria an individual must meet to be a QRTP.
5.Permits DHCS to adopt additional requirements for Medi-Cal
coverage of CRT, including a specialty evaluation by a PT, OT,
or other licensed health care professional approved by DHCS.
Prohibits the licensed health professional performing the
specialty evaluation from having a financial relationship with
the CRT.
6.Defines a "complex rehabilitation technology provider" (CRT
provider) as a company or entity that complies with all of the
following:
a. Meets the supplier and quality standards
established for a durable medical equipment (DME)
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;
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c. Employs or contracts with at least one QRTP
for each distribution location;
d. Has the QRTP physically present for the
evaluation and determination of the complex
rehabilitation technology provided; and,
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.
7.Deletes the authority of DHCS to recognize a credentialing
organization of a qualified rehabilitation professional other
than an individual who is a member of the NRRTS.
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.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations: 16- 0
Assembly Floor: 76- 0
COMMENTS :
1.Author's statement. According to the author, AB 582
establishes enhanced consumer protections by requiring CRT
providers to service and repair the equipment they provide.
Additionally this bill establishes CRT services as a separate
benefit under the Medi-Cal program, differentiating it from
other less complicated/costly DME and updating current code to
reflect contemporary terminology and credentialing options.
Used properly complex rehab technology helps promote
independence, avoid institutionalization and reduce related
medical complications. AB 582 is necessary to ensure that this
cost-beneficial category of products/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.
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2.Background. DME is a covered benefit in Medi-Cal, subject to
utilization controls (through a TAR), and includes hospital
beds, wheelchairs, and walkers. CRT is a subset of DME
involving complex adjustable custom-fitted electronic devices
intended for long-term use by individuals with progressive
diagnoses that can be designed to provide pressure management,
and accommodate ventilators. This bill makes a number of
changes to existing law. The rationale for the proposed
changes made by this bill, as provided by proponents, are as
follows:
a. Renaming CRE to CRT. This bill renames CRE to CRT and
deletes power scooters from the definition. The purpose of
the change from "equipment" to "technology" is to use the
term currently used by providers, payers and others to
describe these items, and to distinguish these products
(which are complex adjustable electrical equipment) from
other DME products, which typically involve a static piece
of equipment. Power scooters are deleted from the
definition of CRE because scooters are not considered
complex rehabilitation technology because they do not
involve the customization or hands-on attention that
technology items require (patient assessment, selection of
parts from various sources, individual configuration,
assembly, fit, periodic adjustment, maintenance, and
service).
b. Definition and requirement for CRTP. This bill defines a
CRTP as a company or entity that meets specified criteria,
providing patients with prompt services and repair for all
CRT supplied. The purpose of this change is to ensure that
CRTPs meet minimum standards for competent provision of
CRT, to ensure provider integrity, and to strengthen the
provision of repair services so that CRTP must "service
what they sell" because access to these services has become
problematic for consumers.
c. Separate benefit in Medi-Cal. This bill requires CRT to
be recognized as a separate benefit by the Medi-Cal program
in both fee-for-service and managed care delivery systems.
The purpose of this change is to distinguish CRT from other
types of DME, and is intended to have DHCS differentiate
CRT from DME when evaluating access, formulating policies,
establishing purchasing practices, adopting utilization
controls, setting reimbursement rates, and audit guidelines
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in this critical area.
d. Medi-Cal managed care contracts. This bill requires
contracts initiated by DHCS with Medi-Cal managed care
plans to be consistent with the requirements of this bill.
The purpose of this provision is to ensure that the
standards for CRT provided to Medi-Cal beneficiaries is
consistent across all payer types.
e. QRP definition. Existing law defines a QRP, and this
bill deletes from that definition PT, OTs and other
qualified health care professionals. This bill would
instead permit DHCS to adopt additional requirements for
Medi-Cal coverage of CRT, including a specialty evaluation
by a PT, OT, or other licensed health care professional
approved by DHCS. This change was made because OTs and PTs
are not typically hired (or contracted) as part of the CRTP
that furnish the CRT to the patient. Instead, PTs and OTs
are typically part of the medical team that determines the
need and appropriate type of technology for a patient.
f. Credentialing organization changes. In addition, this
bill deletes the authority of DHCS to recognize a separate
credentialing organization other than the NRRTS. This bill
also requires the QRP to hold the designation of Certified
Complex Rehabilitation Technology Specialist or requires
the individual to have successfully passed the
credentialing examination and received the credential of
Assistive Technology Professional from RESNA. This bill
deletes the three examinations listed in existing law. The
rationale for these changes is there are no other
comparable credentialing organizations other than NRRTS,
and the listed exams are no longer offered and have been
replaced by the 'Assistive Technology Professional' exam
and credential now offered by NRRTS.
3.Prior legislation. AB 258 (Matthews) Chapter 523, Statutes of
2005 established the requirements in existing law regarding
CRE, CRTs, and QRP. AB 258 also required that a physical
examination be conducted before a motorized wheelchair or
scooter is prescribed, and required the prescribing medical
provider to complete a certificate of medical necessity,
developed by DHCS for the motorized wheelchair or scooter.
4.Support. This bill is supported by DME providers, patient and
low-income advocacy groups to provide a better focus on the
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provision of this specialized equipment and to ensure CRT
providers offer service and maintenance so as to ensure
greater access to repair services by patients. The National
Multiple Sclerosis Society - CA Action Network, a co-sponsor
of this bill, argues this bill will result in well-functioning
CRT equipment and less consumer cost for on-going CRT upkeep
and modifications. MS Society states that, for those who
depend on a wheelchair, good-functioning CRT can mean the
difference between independence and being immobile.
5.Policy issues.
a. This bill deletes the authority of DHCS to recognize
a separate credentialing organization other than RESNA.
The rationale for this change is there is not a currently
comparable organization. However, limiting the
credentialing organization in statute to one entity
grants that entity a great deal of authority over the
profession which the proponents indicate is already in
short supply. It may be appropriate to continue to grant
DHCS the authority to recognize other credentialing
organizations in the event credentialing entities other
RESNA emerge in the future.
b. This bill prohibits the licensed health professional
performing the specialty evaluation from having a
financial relationship with the complex rehabilitation
technology. This provision is intended to refer to the
relationship between the health care professional and the
complex rehabilitation technology provider . An amendment
is needed to clarify this provision.
SUPPORT AND OPPOSITION :
Support: National Multiple Sclerosis Society-California Action
Network (co-sponsor)
Assistive Technology Group
California ALS Advocacy Committee
California Chronic Care Coalition
California Physical Therapy Association
California Association of Medical Product Suppliers
Multiple Sclerosis Society - California Action
Committee
State Independent Living Council
Western Center on Law and Poverty
Oppose: None received.
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