Bill Text: CA AB582 | 2013-2014 | Regular Session | Amended

California Assembly Bill 582 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Palm Drive Health Care District: certificates of participation: lien.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Passed) 2014-06-16 - Chaptered by Secretary of State - Chapter 23, Statutes of 2014. [AB582 Detail]

Download: California-2013-AB582-Amended.html
BILL NUMBER: AB 582	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 13, 2013
	AMENDED IN ASSEMBLY  MAY 24, 2013
	AMENDED IN ASSEMBLY  APRIL 1, 2013

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,  only  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  any   either  one of
the following applies: 
   (A) The individual is a physical therapist licensed pursuant to
Chapter 5.7 (commencing with Section 2600) of Division 2 of the
Business and Professions Code, occupational therapist licensed
pursuant to Chapter 5.6 (commencing with Section 2570) of Division 2
of the Business and Professions Code, or other qualified health care
professional approved by the department.  
   (B) 
    (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. 
   (C) 
    (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 (RESNA).
   (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
technology.  
   (e) 
    (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. 
   (f) 
    (g)  Contracts initiated by the department with managed
care plans shall be consistent with the requirements of this section.

   (g) 
    (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.