Amends title XVIII (Medicare) of the Social Security Act to provide for coverage under Medicare of certain medical mobility devices approved as a class III medical device pursuant to a premarket approval application under the Federal Food, Drug, and Cosmetic Act.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6260 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 6260
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program of certain medical mobility devices approved
as class III medical devices.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 29, 2006
Mr. Bass (for himself, Mr. Langevin, Mr. Ramstad, Mr. Ferguson, Mr.
Nunes, Mr. Issa, and Mr. Jindal) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program of certain medical mobility devices approved
as class III medical devices.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. MEDICARE COVERAGE OF CLASS III MEDICAL MOBILITY DEVICES.
(a) Covered Benefit.--Section 1861(s)(2) of the Social Security Act
(42 U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (Z), by striking ``and'' at the end;
(2) in subparagraph (AA), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(BB) class III medical mobility devices (as defined in
subsection (ccc)(1)) furnished to a class III medical mobility-
device eligible individual (as defined in subsection
(ccc)(2));''.
(b) Definitions.--Section 1861 of such Act (42 U.S.C. 1395x) is
amended by adding at the end the following new subsection:
``Class III Medical Mobility Device; Class III Medical Mobility-Device
Eligible Individual
``(ccc)(1) The term `class III medical mobility device' means a
medical mobility device that has been approved as a class III medical
device pursuant to a premarket approval application under the Federal
Food, Drug, and Cosmetic Act and that--
``(A) is able, among other functions--
``(i) to ascend and descend stairs using a climbing
and descending function;
``(ii) to traverse different terrain and various
obstacles (including uneven terrain, curbs of 5 inches
in height, grass, gravel and other soft surfaces) using
a 4-wheel drive function; and
``(iii) to provide mobility in a seated position at
an elevated height using a balance function;
``(B) has been prescribed for a class III medical mobility-
device eligible individual (as defined in paragraph (2)) by the
individual's treating physician (as defined in subsection
(r)(1)) for an approved indication of the class III medical
mobility device; and
``(C) is only dispensed after an assessment of the class
III medical mobility-device eligible individual has been
completed by a health care professional specified in paragraph
(3) who has successfully completed training in making such
assessments under standards specified by the Secretary in
consultation with representatives of appropriate industry and
medical organizations.
``(2) The term `class III medical mobility-device eligible
individual' means, with respect to a class III medical mobility device,
an individual who, at the time the prescription for the device is
written, meets each of the following requirements:
``(A) The individual suffers from a functional limitation
of mobility that hinders the individual's ability to perform
mobility-related activities of daily living.
``(B) The individual demonstrates sufficient cognitive and
physical ability for the proper and safe operation of the
device (such as sufficient use of one upper extremity and the
ability to dial a push button telephone or operate a hand
operated joystick) under such medical standards as the
Secretary may specify.
``(C) The individual meets drivers licensing criteria
established in 1996 by the Epilepsy Foundation of America.
``(D) The individual does not require mechanical
ventilation.
``(E) The individual is not a resident of an institution
that meets the requirements of subsection (e)(1) or section
1819(a)(1).
``(F) The individual has completed a comprehensive training
program (that meets standards developed by the Secretary in
consultation with appropriate industry representatives) on the
safe operation of the class III medical mobility device and its
functions.
``(3) A health care professional specified in this paragraph is any
of the following:
``(A) A physician (as defined in subsection (r)(1)).
``(B) A physician assistant.
``(C) A nurse practitioner.
``(D) A qualified physical therapist.
``(E) A qualified occupational therapist.''.
(c) Conforming Amendments.--
(1) Provision of class iii medical mobility device only to
class iii medical mobility-device eligible individuals; medical
necessity.--Section 1862 of such Act (42 U.S.C. 1395y) is
amended--
(A) in subsection (a)(1)--
(i) in subparagraph (M), by striking
``and'' at the end;
(ii) in subparagraph (N), by striking the
semicolon at the end and inserting ``, and'';
and
(iii) by inserting after subparagraph (N)
the following new subparagraph:
``(O) in the case of a class III medical mobility
device (as defined in paragraph (1) of section
1861(ccc)), which is furnished other than to a class
III medical mobility-device eligible individual (as
defined in paragraph (2) of such section);''; and
(B) by adding at the end the following new
subsection:
``(n) Clarification of Coverage of and Payment for All Functions of
Class Iii Medical Mobility Devices.--In the case of a class III medical
mobility device (as defined in section 1861(ccc)(1)) furnished to a
class III medical mobility-device eligible individual, each function of
such device, including the functions described in subparagraph (A) of
such section, are deemed for purposes of subsection (a)(1), to be
reasonable and necessary for the treatment of an illness or injury or
to improve the functioning of a malformed body member.''.
(2) Payment in connection with covered items; purchase
agreement option; maintenance.--Section 1834(a) of such Act (42
U.S.C. 1395m(a)) is amended--
(A) in paragraph (1)(B)(ii), by inserting ``and
(22) in the case of a class III medical mobility
device,'' after ``(7)'';
(B) in paragraph (13), by inserting before the
period at the end the following: ``, and also includes
a class III medical mobility device (as defined in
section 1861(ccc)(1))''; and
(C) by adding at the end the following new
paragraph:
``(22) Payment for class iii medical mobility devices.--
``(A) In general.--Subject to the succeeding
provisions of this paragraph, in the case of a class
III medical mobility device (as defined in section
1861(ccc)(1)), the provisions of paragraph (7)
(including the option for a purchase agreement under
subparagraph (A)(iii) of such paragraph) shall apply to
such device under this paragraph in the same manner as
those provisions apply to a covered item under
paragraph (7).
``(B) Payment for all functions of class iii
medical mobility devices.--In the case of a class III
medical mobility device, payment under this paragraph
for such device shall be made taking into account all
functions of such device, consistent with section
1862(n).
``(C) Limitation on aggregate number of devices
covered during 2007 through 2011.--With respect to
class III medical mobility devices furnished during
each of 2007 through 2011, payment shall only be made
under this subsection for 1,000 such devices furnished
in each such year. The limitation on payment under the
preceding sentence for class III medical mobility
devices shall not apply with respect to any year
beginning after 2011.''.
(3) Requirement for face-to-face encounter with a physician
and for written prescription.--Clause (iv) of section
1834(a)(1)(E) of such Act (42 U.S.C. 1395m(a)(1)(E)) is
amended--
(A) by adding at the end the following: ``In the
case of a covered item consisting of a class III
medical mobility device (as defined in paragraph (1) of
section 1861(ccc)) for a class III medical mobility-
device eligible individual (as defined in paragraph (2)
of such section), payment may not be made for such item
unless a physician (as so defined) has conducted a
face-to-face examination and written a prescription for
the item, and after an assessment of such individual
has been completed by a health care professional
specified in paragraph (3) of such section.''; and
(B) in the heading, by inserting ``and class iii
medical mobility devices'' after ``wheelchairs''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2007.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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