AB 462

This bill requires the Department of Health Services to establish rules and

policies for access to complex rehabilitation technology by complex needs patients

who are recipients of Medical Assistance. Under the bill, a “complex needs patient”

is an individual with a diagnosis or medical condition that results in significant

physical impairment or functional limitation, and “complex rehabilitation

technology” means items classified within Medicare 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.

The bill requires the department to include in its rules certain provisions including,

among other things: designation of billing codes as complex rehabilitation

technology; establishment of specific supplier standards for companies and entities

that provide complex rehabilitation technology and limiting reimbursement only to

suppliers that are qualified complex rehabilitation technology suppliers;

establishment and maintenance of payment rates for complex rehabilitation

technology that are adequate to ensure complex needs patients have access to

complex rehabilitation technology; and a requirement for contracts with the

department that managed care plans providing services to Medical Assistance

recipients comply with the rules promulgated by the department. Finally, the bill

specifies that complex rehabilitation technology, as defined in the bill, is a benefit

under the Medical Assistance program.