Medi-Cal: complex rehabilitation technology.

Plain English Breakdown

The official source material does not provide information on payment methods or costs associated with the repairs.

Medi-Cal: Rules for Repairing Wheelchairs

This law changes Medi-Cal rules to allow repairs costing less than $1,250 for certain wheelchairs without needing special permission from the government.

What This Bill Does

• Changes Medi-Cal rules so that repairs costing less than $1,250 for CRT-powered wheelchairs do not need prior approval.
• Allows suppliers to fix CRT-powered wheelchairs without a new prescription or proof of medical necessity if the wheelchair was already approved by the patient's doctor.
• Requires suppliers to keep detailed records about repairs and labor costs, which will be checked later by the government.

Who It Names or Affects

• People who use CRT-powered wheelchairs through Medi-Cal
• Health care providers and suppliers of CRT-powered wheelchairs

Terms To Know

Medi-Cal

A government health insurance program for low-income people in California.

Complex Rehabilitation Technology (CRT)

Specialized medical equipment like wheelchairs that help people with disabilities move around and live independently.

Limits and Unknowns

• The bill does not specify when it will take effect or how much it will cost.
• It is unclear if the federal government will approve these changes since Medi-Cal rules are partly set by federal law.

Official Summary Text

AB 1561, as amended, Krell.
Medi-Cal: complex rehabilitation technology.
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.
Existing law 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 a Medi-Cal beneficiary to comply with certain
standards and accreditation requirements. Existing law conditions implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.
standards, including with regard to CRT repairs. Existing law authorizes the department to adopt any utilization controls for CRT, as appropriate.
This bill would make a technical, nonsubstantive change to those provisions.
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.
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.

Current Bill Text

Download Bill PDF