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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2025-02-10</ns0:ActionDate>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Krell</ns0:AuthorText>
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<ns0:Name>Krell</ns0:Name>
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<ns0:Title> An act to amend Section 14132.85 of the Welfare and Institutions Code, relating to Medi-Cal.</ns0:Title>
<ns0:RelatingClause>Medi-Cal</ns0:RelatingClause>
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<ns0:Subject>Medi-Cal: complex rehabilitation technology: wheelchairs.</ns0:Subject>
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<html:p>Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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.</html:p>
<html:p>Existing law, subject to any necessary federal approvals, sets forth various Medi-Cal provisions relating to complex rehabilitation technology (CRT), which is a form of durable medical equipment, including, but not limited to, complex rehabilitation manual and power wheelchairs. Existing law requires a CRT provider to comply with certain standards, including with regard to CRT repairs. Existing law authorizes the department to adopt any utilization controls for CRT, as appropriate.</html:p>
<html:p>This bill would prohibit the department from requiring prior authorization for the repair of a CRT-powered wheelchair if the cost of the repair does
not exceed $1,250. Under the bill, a treatment authorization request for repair or replacement of a CRT-powered wheelchair would not require an individual prescription or documentation of medical necessity from the treating practitioner if the CRT-powered wheelchair has already been approved for use by the patient.</html:p>
<html:p>For repair of a CRT-powered wheelchair, the bill would require the supplier to document and maintain records of the items being repaired, the reason for the repair, and the labor details, as specified, with the information being subject to a postpayment audit by the department. The bill would set forth other recording requirements for the supplier.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 14132.85 of the
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is amended to read:
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<ns0:Num>14132.85.</ns0:Num>
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(a)
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For purposes of this section, the following definitions apply:
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(1)
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“Complex needs patient” means an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation. “Complex needs patient” includes, but is not limited to, individuals with spinal cord injury, traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclerosis, multiple sclerosis, demyelinating disease, myelopathy, myopathy, progressive muscular atrophy, anterior horn cell disease, post-polio syndrome, cerebellar degeneration, dystonia, Huntington’s disease, spinocerebellar disease, and the types of amputation, paralysis, or paresis that result in significant physical impairment or functional limitation. “Complex needs patient” does
not negate the requirement that an individual meet medical necessity requirements under authority rules to qualify for receiving complex rehabilitation technology.
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(2)
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“Complex rehabilitation technology” means items classified within the federal Medicare Program as of January 1, 2021, as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary. These items include, but are not limited to, complex rehabilitation manual and power wheelchairs, power seat elevation or power standing components of power wheelchairs, seating and positioning items, other specialized equipment such as adaptive bath equipment, standing frames, gait trainers, and specialized strollers, and related options and accessories.
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(3)
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“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 or other function or need. These services include, but are not limited to, all of the following:
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(A)
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Evaluating 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.
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(B)
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Documenting medical necessity.
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(C)
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Selecting, fitting, customizing, maintaining, assembling, repairing, replacing, picking up and delivering, and testing equipment and parts.
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(D)
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Training the patient who will use the technology or any individual who assists the patient in using the complex rehabilitation technology.
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(4)
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“Qualified health care professional” means an
individual who has no financial relationship to the provider of complex rehabilitation technology and is any of the following:
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(A)
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A physical therapist licensed pursuant to Chapter 5.7 (commencing with Section 2600) of Division 2 of the Business and Professions Code.
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(B)
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An occupational therapist licensed pursuant to Chapter 5.6 (commencing with Section 2570) of Division 2 of the Business and Professions Code.
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(C)
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Other licensed health care professional, approved by the department, and who performs specialty evaluations within the professional’s scope of practice.
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(5)
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“Qualified rehabilitation technology professional” means an individual who meets either of the following:
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<html:p>
(A)
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Holds the credential of Assistive Technology Professional (ATP) from the Rehabilitation Engineering and Assistive Technology Society of North America.
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(B)
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Holds the
credential of Certified Complex Rehabilitation Technology Supplier (CRTS) from the National Registry of Rehabilitation Technology Suppliers.
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<html:p>
(b)
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A provider of complex rehabilitation technology to a Medi-Cal beneficiary shall comply with all of the following:
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<html:p>
(1)
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Meet the supplier and quality standards established for a durable medical equipment supplier under the federal Medicare Program and be enrolled as a provider in the Medi-Cal program.
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(2)
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Be accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology.
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(3)
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Employ at least one qualified rehabilitation technology professional as a W-2 employee (receiving a W-2 tax form from the provider) for each distribution location.
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<html:p>
(4)
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Have the qualified rehabilitation technology professional physically present for the evaluation, either in person or remotely if necessary, directly
involved in determining the specific complex rehabilitation technology appropriate for the patient, and directly involved with, or closely supervised in, the final fitting and delivery of the complex rehabilitation technology.
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(5)
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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 complex rehabilitation technology supplied.
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(6)
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Provide written information at the time of delivery of complex rehabilitation technology regarding how the patient may receive services and repair.
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<html:p>
(c)
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For complex needs patients receiving a complex rehabilitation manual wheelchair, power wheelchair, or seating component, the patient shall be evaluated, either in person or remotely if necessary, by both of the following:
</html:p>
<html:p>
(1)
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A qualified health care professional.
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(2)
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A
qualified rehabilitation technology professional.
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<html:p>
(d)
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A medical provider shall conduct a physical examination of an individual, either in person or remotely if necessary, before prescribing a power wheelchair or scooter for a Medi-Cal beneficiary. The medical provider shall complete a certificate of medical necessity that documents the medical condition that necessitates the power wheelchair or scooter, and verifies that the patient is capable of using the wheelchair or scooter safely.
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<html:p>
(e)
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(1)
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The department may adopt utilization controls, including a specialty evaluation by a qualified health care professional, as defined in paragraph (4) of subdivision (a).
Except as provided in paragraph (2), the department may adopt any other additional utilization controls for complex rehabilitation technology, as appropriate.
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<html:p>
(2)
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(A)
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The department shall not require prior authorization for the repair of a complex rehabilitation technology (CRT)-powered wheelchair if the cost of the repair does not exceed one thousand two hundred fifty dollars ($1,250).
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<html:p>
(B)
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A treatment authorization request for repair or replacement of a CRT-powered wheelchair shall not require an individual prescription or documentation of medical necessity from the treating practitioner for repairs or replacement if the CRT-powered wheelchair has already been approved for use by the patient.
</html:p>
<html:p>
(C)
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For repair of a CRT-powered wheelchair, the supplier shall document and maintain records of the items
being repaired, the reason for the repair, and the labor details associated with the repair in the supplier’s files. This documentation shall be available upon request by, and may be subject to a postpayment audit conducted by, the department.
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<html:p>
(D)
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If a CRT-powered wheelchair is not already on file with the Medi-Cal program, whether through the department or a Medi-Cal managed care plan, the supplier shall ensure that the equipment and related repair details are recorded in a manner that demonstrates proof of continuous medical need. Once the CRT-powered wheelchair is recorded, any subsequent repairs shall follow the process outlined in this paragraph and remain subject to postpayment audits by the department.
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<html:p>
(f)
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The department shall seek any necessary federal approvals for the implementation of this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and
that federal financial participation is available and is not otherwise jeopardized.
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