BILL NUMBER: AB 1985INTRODUCED BILL TEXT INTRODUCED BY Assembly Member Galgiani FEBRUARY 17, 2010 An act to add Section 5024.3 to the Penal Code, relating to Department of Corrections and Rehabilitation. LEGISLATIVE COUNSEL'S DIGEST AB 1985, as introduced, Galgiani. Corrections: medical equipment and care. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, pursuant to which medical benefits are provided to low-income persons. Existing law requires the department to establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment, as defined. Existing law requires that reimbursement for all durable medical equipment billed to the Medi-Cal program be the lesser of certain amounts. This bill would permit the Department of Corrections and Rehabilitation, upon approval by the federal receiver, if necessary, to establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment used for inmate medical care. It would provide that reimbursement for these items of durable medical equipment may be the lesser of specified amounts. The bill would permit the department to establish capped rental reimbursement for specific items of durable medical equipment. It would require that items in this category be reimbursed on a monthly rental basis, as prescribed. 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. Section 5024.3 is added to the Penal Code, to read: 5024.3. Upon approval of the federal receiver, or at such time as the Department of Corrections and Rehabilitation is no longer under the authority of the federal receiver, the Department of Corrections and Rehabilitation may do all of the following: (a) The department may establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment as defined in Section 51160 of Title 22 of the California Code of Regulations. The list may specify utilization controls to be applied to each type of durable medical equipment. (b) The department may set reimbursement for durable medical equipment, except wheelchairs, wheelchair accessories, and speech-generating devices and related accessories, at the lesser of (1) the amount billed pursuant to Section 51008.1 of Title 22 of the California Code of Regulations, (2) an amount that does not exceed 80 percent of the lowest maximum allowance for California established by the federal Medicare Program for the same or similar item or service, or (3) the guaranteed acquisition cost negotiated by means of the contracting process provided for pursuant to Section 14105.3 of the Welfare and Institutions Code plus a percentage markup to be established by the department. (c) The department may set reimbursement for wheelchairs, wheelchair accessories, and speech-generating devices and related accessories at the lesser of (1) the amount billed pursuant to Section 51008.1 of Title 22 of the California Code of Regulations, (2) an amount that does not exceed 100 percent of the lowest maximum allowance for California established by the federal Medicare Program for the same or similar item or service, or (3) the guaranteed acquisition cost negotiated by means of the contracting process provided for pursuant to Section 14105.3 of the Welfare and Institutions Code plus a percentage markup to be established by the department. (d) The department may set reimbursement for all durable medical equipment billed to the department utilizing codes with no specified maximum allowable rate at the lesser of (1) the amount billed pursuant to Section 51008.1 of Title 22 of the California Code of Regulations, (2) the guaranteed acquisition cost negotiated by means of the contracting process provided for pursuant to Section 14105.3 of the Welfare and Institutions Code plus a percentage markup to be established by the department, (3) the actual acquisition cost plus a markup to be established by the department, (4) the manufacturer's suggested retail purchase price on June 1, 2006, and documented by a printed catalog or a hard copy of an electronic catalog page showing the price on that date, reduced by a percentage discount not to exceed 20 percent, or not to exceed 15 percent for wheelchairs and wheelchair accessories if the provider employs or contracts with a qualified rehabilitation professional, as defined in paragraph (3) of subdivision (c) of Section 14105.485 of the Welfare and Institutions Code, or (5) a price established through targeted product-specific cost containment provisions developed with providers. (e) The department may set reimbursement for all durable medical equipment supplies and accessories billed to the department at the lesser of (1) the amount billed pursuant to Section 51008.1 of Title 22 of the California Code of Regulations, or (2) the acquisition cost plus a 23-percent markup. (f) The department may establish "capped rental" reimbursement for specific items of durable medical equipment. Items in this category may be reimbursed on a monthly rental basis not to exceed a period of continuous use of 10 months. After 10 months of rent have been paid, the provider shall continue to provide the item without charge, except for maintenance and servicing fees, until the medical necessity ends. If the department establishes "capped rental" reimbursement pursuant to this subdivision, monthly reimbursement for the rental of these specific items of durable medical equipment may not exceed 80 percent of the lowest maximum allowance for California established by the federal Medicare Program for the same or similar item or service. (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of the Government Code, actions under subdivisions (a) and (f) shall not be subject to the rulemaking provisions of the Administrative Procedures Act or to the review and approval of the Office of Administrative Law.